Healthcare Provider Details

I. General information

NPI: 1164422713
Provider Name (Legal Business Name): SCOTT E GLOSNER PHARMD, BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 CHATHAM AVE
ELMHURST IL
60126-4528
US

IV. Provider business mailing address

795 CHATHAM AVE
ELMHURST IL
60126-4528
US

V. Phone/Fax

Practice location:
  • Phone: 630-516-9976
  • Fax: 630-516-0929
Mailing address:
  • Phone: 630-516-9976
  • Fax: 630-516-0929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number26016620A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: