Provider Demographics
NPI:1932235884
Name:GLASGOW, EVANS R JR (RPH)
Entity Type:Individual
Prefix:
First Name:EVANS
Middle Name:R
Last Name:GLASGOW
Suffix:JR
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:PO BOX 918
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-0918
Mailing Address - Country:US
Mailing Address - Phone:985-748-8191
Mailing Address - Fax:985-748-5766
Practice Address - Street 1:512 N 2ND ST
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-2123
Practice Address - Country:US
Practice Address - Phone:985-748-8191
Practice Address - Fax:985-748-5766
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14386183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA14386OtherLA PHARMACIST LICENSE