Provider Demographics
NPI:1144417809
Name:GLASCOCK, TIMOTHY BRYAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:BRYAN
Last Name:GLASCOCK
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 1:3908 TENNESSEE AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37409-1325
Mailing Address - Country:US
Mailing Address - Phone:423-821-0810
Mailing Address - Fax:
Practice Address - Street 1:3908 TENNESSEE AVE
Practice Address - Street 2:SUITE F
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37409-1325
Practice Address - Country:US
Practice Address - Phone:423-821-0810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC006704183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist