Provider Demographics
NPI:1861775074
Name:GLASS, JAMES C (RPH)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:GLASS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 NORTHLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33403-1702
Mailing Address - Country:US
Mailing Address - Phone:561-776-3037
Mailing Address - Fax:561-776-3046
Practice Address - Street 1:3250 NORTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33403-1702
Practice Address - Country:US
Practice Address - Phone:561-776-3037
Practice Address - Fax:561-776-3046
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS25491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist