Provider Demographics
NPI:1710379565
Name:GLASER, MELODY LYN (RPH)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:LYN
Last Name:GLASER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5606 SUGAR CAMP RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-9673
Mailing Address - Country:US
Mailing Address - Phone:513-576-0338
Mailing Address - Fax:
Practice Address - Street 1:12164 LEBANON RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-1799
Practice Address - Country:US
Practice Address - Phone:513-733-4945
Practice Address - Fax:513-733-5058
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-23053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist