Healthcare Provider Details

I. General information

NPI: 1518494822
Provider Name (Legal Business Name): GREGORY CLIFTON GLASS PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 05/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3456 HILLCREST RD BLDG B STE D
MOBILE AL
36695
US

IV. Provider business mailing address

3456 HILLCREST RD BLDG B STE D
MOBILE AL
36695
US

V. Phone/Fax

Practice location:
  • Phone: 251-665-4521
  • Fax: 251-665-4522
Mailing address:
  • Phone: 251-665-4521
  • Fax: 251-665-4522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15123
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: