Provider Demographics
NPI:1386732618
Name:BARTHOLOMEW, DAVID GLENN
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:GLENN
Last Name:BARTHOLOMEW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:GLENN
Other - Last Name:BARTHOLOMEW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7040 OAKLEIGH DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-2935
Mailing Address - Country:US
Mailing Address - Phone:702-636-4040
Mailing Address - Fax:
Practice Address - Street 1:2455 W CHEYENNE AVE
Practice Address - Street 2:ROOM 112
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-4325
Practice Address - Country:US
Practice Address - Phone:702-636-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT138835-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist