Provider Demographics
NPI:1861779027
Name:GLISPIE, CHARLOTTE AMANDA (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:AMANDA
Last Name:GLISPIE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MRS
Other - First Name:CHARLOTTE
Other - Middle Name:AMANDA
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:12625 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-1724
Mailing Address - Country:US
Mailing Address - Phone:708-388-1200
Mailing Address - Fax:708-388-7875
Practice Address - Street 1:12625 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-1724
Practice Address - Country:US
Practice Address - Phone:708-388-1200
Practice Address - Fax:708-388-7875
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051291625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist