Provider Demographics
NPI:1417260514
Name:GLASS, JAMES DENNIS (DPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DENNIS
Last Name:GLASS
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 GREENFIELD PL
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-6119
Mailing Address - Country:US
Mailing Address - Phone:423-968-7032
Mailing Address - Fax:423-968-3933
Practice Address - Street 1:2854 W STATE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1711
Practice Address - Country:US
Practice Address - Phone:423-968-7032
Practice Address - Fax:423-968-3933
Is Sole Proprietor?:No
Enumeration Date:2010-07-17
Last Update Date:2010-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7758183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist