Provider Demographics
NPI:1912923657
Name:GLASER, ROGER C (RPH)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:C
Last Name:GLASER
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 1:815 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-3413
Mailing Address - Country:US
Mailing Address - Phone:509-925-4851
Mailing Address - Fax:509-925-1545
Practice Address - Street 1:414 N PEARL ST
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3112
Practice Address - Country:US
Practice Address - Phone:509-925-1514
Practice Address - Fax:509-925-1545
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00009365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist