Provider Demographics
NPI:1912188756
Name:GLAZ, BARRY D (RPH)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:D
Last Name:GLAZ
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 1:11 WELLINGTON CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-7839
Mailing Address - Country:US
Mailing Address - Phone:718-494-8350
Mailing Address - Fax:718-494-8350
Practice Address - Street 1:2271 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3903
Practice Address - Country:US
Practice Address - Phone:718-698-0500
Practice Address - Fax:718-370-0590
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033316183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01921791Medicaid