Provider Demographics
NPI:1154109403
Name:GLASER, JOSEPH (RPH)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
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 1:12 WILMONT TURN
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-1034
Mailing Address - Country:US
Mailing Address - Phone:631-942-9698
Mailing Address - Fax:
Practice Address - Street 1:229 INDEPENDENCE PLZ
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2417
Practice Address - Country:US
Practice Address - Phone:631-698-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist