Provider Demographics
NPI:1730419748
Name:GLESSING, MICHAEL GARY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GARY
Last Name:GLESSING
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 SOUTH DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4937
Mailing Address - Country:US
Mailing Address - Phone:701-212-9178
Mailing Address - Fax:701-232-5216
Practice Address - Street 1:123 BROADWAY N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4925
Practice Address - Country:US
Practice Address - Phone:701-232-6150
Practice Address - Fax:701-232-5216
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5223183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist