Provider Demographics
NPI:1134416738
Name:GLOS, NICOLE MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:GLOS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 CARDINAL WAY
Mailing Address - Street 2:UNIT J
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-2935
Mailing Address - Country:US
Mailing Address - Phone:410-459-3918
Mailing Address - Fax:410-420-8228
Practice Address - Street 1:2101 ROCK SPRING RD
Practice Address - Street 2:PHARMACY
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-2617
Practice Address - Country:US
Practice Address - Phone:410-420-8224
Practice Address - Fax:410-420-8228
Is Sole Proprietor?:No
Enumeration Date:2011-07-03
Last Update Date:2011-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist