Healthcare Provider Details

I. General information

NPI: 1912188756
Provider Name (Legal Business Name): BARRY D GLAZ RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2271 RICHMOND AVE
STATEN ISLAND NY
10314-3903
US

IV. Provider business mailing address

11 WELLINGTON CT
STATEN ISLAND NY
10314-7839
US

V. Phone/Fax

Practice location:
  • Phone: 718-698-0500
  • Fax: 718-370-0590
Mailing address:
  • Phone: 718-494-8350
  • Fax: 718-494-8350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number033316
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: