Provider Demographics
NPI:1851455281
Name:GLASCOCK, GARY FRANK (RPH)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:FRANK
Last Name:GLASCOCK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 PEARL ST
Mailing Address - Street 2:#208
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-3324
Mailing Address - Country:US
Mailing Address - Phone:303-831-1392
Mailing Address - Fax:
Practice Address - Street 1:15000 W 6TH AVE
Practice Address - Street 2:#300
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-6586
Practice Address - Country:US
Practice Address - Phone:800-310-1008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10189183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist