Healthcare Provider Details

I. General information

NPI: 1669395265
Provider Name (Legal Business Name): JEAN LEE GLASER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 W MAIN ST
NEWARK OH
43055-1822
US

IV. Provider business mailing address

1320 W MAIN ST
NEWARK OH
43055-1822
US

V. Phone/Fax

Practice location:
  • Phone: 220-564-4544
  • Fax:
Mailing address:
  • Phone: 220-564-4544
  • Fax: 220-564-4546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15909
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: