Provider Demographics
NPI:1518494822
Name:GLASS, GREGORY CLIFTON (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:CLIFTON
Last Name:GLASS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3456 HILLCREST RD
Mailing Address - Street 2:BLDG B STE D
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695
Mailing Address - Country:US
Mailing Address - Phone:251-665-4521
Mailing Address - Fax:251-665-4522
Practice Address - Street 1:3456 HILLCREST RD
Practice Address - Street 2:BLDG B STE D
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695
Practice Address - Country:US
Practice Address - Phone:251-665-4521
Practice Address - Fax:251-665-4522
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15123183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist