Provider Demographics
NPI:1033457247
Name:DASHER, SALLY GLASCOCK
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:GLASCOCK
Last Name:DASHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11030 S MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-2120
Mailing Address - Country:US
Mailing Address - Phone:256-650-1543
Mailing Address - Fax:256-650-1597
Practice Address - Street 1:11030 S MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35803-2120
Practice Address - Country:US
Practice Address - Phone:256-650-1543
Practice Address - Fax:256-650-1597
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH014380183500000X
FLPS20293183500000X
AL10863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist