Provider Demographics
NPI:1851650741
Name:GLASSO, GERARD P (RPH)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:P
Last Name:GLASSO
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 1:881 THRONE DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-1411
Mailing Address - Country:US
Mailing Address - Phone:541-337-7134
Mailing Address - Fax:209-231-7328
Practice Address - Street 1:881 THRONE DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-1411
Practice Address - Country:US
Practice Address - Phone:541-337-7134
Practice Address - Fax:209-231-7328
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0007884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist