Provider Demographics
NPI:1386825818
Name:GLASS, STUART (RPH)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:
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 1:2784 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-3639
Mailing Address - Country:US
Mailing Address - Phone:516-826-3100
Mailing Address - Fax:
Practice Address - Street 1:2784 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-3639
Practice Address - Country:US
Practice Address - Phone:516-826-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist