Provider Demographics
NPI:1154925410
Name:GLAZEBROOK, GARY LAMONT JR (PHARM D)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:LAMONT
Last Name:GLAZEBROOK
Suffix:JR
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 CADBURY CASTLE LN
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-1705
Mailing Address - Country:US
Mailing Address - Phone:713-498-1765
Mailing Address - Fax:
Practice Address - Street 1:5212 ANTOINE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-3316
Practice Address - Country:US
Practice Address - Phone:713-682-2533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52931183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist