Healthcare Provider Details

I. General information

NPI: 1184538670
Provider Name (Legal Business Name): BRENDON GAGE GLASPIE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1544 PIEDMONT AVE NE
ATLANTA GA
30324-5018
US

IV. Provider business mailing address

290 MARTIN LUTHER KING JR DR SE UNIT 2320
ATLANTA GA
30312-2545
US

V. Phone/Fax

Practice location:
  • Phone: 678-360-3647
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPHTC085925
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: