MEDICARE: STEPHANIE ERIN GLESSING PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	5309	ND

General Provider Information

NPI Number	:	1275822199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE ERIN GLESSING PHARM.D.

Provider Business Mailing Address
First Line	:	P.O. BOX 497
Second Line	:	HIGHWAY 1
City	:	RED LAKE
State	:	MN
Zip	:	56671-6671
Country	:	US
Telephone Number	:	218-679-3912
Fax Number	:	218-679-0189

Provider Business Practice Location Address
First Line	:	HWY 1 24760 HOSPITAL DRIVE
Second Line	:
City	:	RED LAKE
State	:	MN
Zip	:	56671-0249
Country	:	US
Telephone Number	:	218-679-3912
Fax Number	:	218-679-0189

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2011
Last Update Date	:	03/31/2011

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