Provider Demographics
NPI:1578538906
Name:GLASSFORD, JAMES LEE (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LEE
Last Name:GLASSFORD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:SKIP
Other - Middle Name:
Other - Last Name:GLASSFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16217 KELLOGG RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-8795
Mailing Address - Country:US
Mailing Address - Phone:419-823-1400
Mailing Address - Fax:
Practice Address - Street 1:970 W WOOSTER ST
Practice Address - Street 2:SUITE #121
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2643
Practice Address - Country:US
Practice Address - Phone:419-352-6423
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-17213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist