Provider Demographics
NPI:1043754799
Name:ASHLINE, GLENN (PHARMD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:ASHLINE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 NYS ROUTE 5
Mailing Address - Street 2:
Mailing Address - City:PALATINE BRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:13428
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6025 NYS ROUTE 5
Practice Address - Street 2:PRICE CHOPPER PHARMACY
Practice Address - City:PALATINE BRIDGE
Practice Address - State:NY
Practice Address - Zip Code:13428
Practice Address - Country:US
Practice Address - Phone:518-673-2366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist