MEDICARE: MS. CHERYL E. GLEMSER 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	PS22842	FL
2	183500000X	Pharmacist	22035	TX

General Provider Information

NPI Number	:	1104125921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHERYL E. GLEMSER R.PH.

Provider Business Mailing Address
First Line	:	6257 N US HIGHWAY 1
Second Line	:
City	:	PORT ST JOHN
State	:	FL
Zip	:	32927-4925
Country	:	US
Telephone Number	:	321-633-8150
Fax Number	:	321-633-6880

Provider Business Practice Location Address
First Line	:	6257 N US HIGHWAY 1
Second Line	:
City	:	PORT ST JOHN
State	:	FL
Zip	:	32927-4925
Country	:	US
Telephone Number	:	321-633-8150
Fax Number	:	321-633-6880

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

Provider Enumeration Date	:	03/18/2011
Last Update Date	:	03/18/2011

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