Provider Demographics
NPI:1942805767
Name:GLASSCO, LISA D (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:D
Last Name:GLASSCO
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 1:1351 BOB WHITE BLVD
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:VA
Mailing Address - Zip Code:24301-4303
Mailing Address - Country:US
Mailing Address - Phone:540-980-8470
Mailing Address - Fax:
Practice Address - Street 1:1351 BOB WHITE BLVD
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:VA
Practice Address - Zip Code:24301-4303
Practice Address - Country:US
Practice Address - Phone:540-980-8470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202214885183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist