Provider Demographics
NPI:1518562511
Name:GLAVAS, VESNA
Entity Type:Individual
Prefix:
First Name:VESNA
Middle Name:
Last Name:GLAVAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1586 STATTEN CT
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-5053
Mailing Address - Country:US
Mailing Address - Phone:440-521-4720
Mailing Address - Fax:
Practice Address - Street 1:265 E ERIE ST
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-3911
Practice Address - Country:US
Practice Address - Phone:440-354-4432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03232570183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist