MEDICARE: GARY R GLISSON R PH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	7023	NC
2	332B00000X	Durable Medical Equipment & Medical Supplies	20733	NC
3	335E00000X	Prosthetic/Orthotic Supplier	20733	NC
4	211D00000X	Podiatric Assistant	20733	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20733	OTHER	NC	BCP-BOARD OF CERTIFICATION IN PEDORTHICS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033111968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY R GLISSON R PH

Provider Business Mailing Address
First Line	:	PO BOX 400
Second Line	:
City	:	NASHVILLE
State	:	NC
Zip	:	27856-0400
Country	:	US
Telephone Number	:	252-459-2135
Fax Number	:	252-459-9300

Provider Business Practice Location Address
First Line	:	117 W CHURCH ST
Second Line	:
City	:	NASHVILLE
State	:	NC
Zip	:	27856-1327
Country	:	US
Telephone Number	:	252-459-2135
Fax Number	:	252-459-9300

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	03/12/2009

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Directions to “ GARY R GLISSON R PH” Practice Location

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