MEDICARE: STEVEN GLAZER

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	049559	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	049559	OTHER	NY	NYS BOARD OF PHARMACY

General Provider Information

NPI Number	:	1215250691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN GLAZER

Provider Business Mailing Address
First Line	:	1930 AVENUE M
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6202
Country	:	US
Telephone Number	:	718-375-2400
Fax Number	:	718-375-3805

Provider Business Practice Location Address
First Line	:	1930 AVENUE M
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6202
Country	:	US
Telephone Number	:	718-375-2400
Fax Number	:	718-375-3805

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

Provider Enumeration Date	:	03/12/2010
Last Update Date	:	03/12/2010

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Directions to “ STEVEN GLAZER ” Practice Location

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