Provider Demographics
NPI:1356692073
Name:GLASSMAN, NORA LEE (RPH)
Entity type:Individual
Prefix:MS
First Name:NORA
Middle Name:LEE
Last Name:GLASSMAN
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 1:4300 RIDGECREST DR SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-5911
Mailing Address - Country:US
Mailing Address - Phone:505-892-2262
Mailing Address - Fax:505-892-1163
Practice Address - Street 1:4300 RIDGECREST DR SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-5911
Practice Address - Country:US
Practice Address - Phone:505-892-2262
Practice Address - Fax:505-892-1163
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007793183500000X
IA19076183500000X
IL051286343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist