MEDICARE: MR. GALE E GLASCOCK 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	RPH015161	GA

General Provider Information

NPI Number	:	1437154945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GALE E GLASCOCK R.PH

Provider Business Mailing Address
First Line	:	50 BISCAYNE DR NW
Second Line	:	UNIT 2114
City	:	ATLANTA
State	:	GA
Zip	:	30309-1041
Country	:	US
Telephone Number	:	404-352-2724
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 BISCAYNE DR NW
Second Line	:	UNIT 2114
City	:	ATLANTA
State	:	GA
Zip	:	30309-1041
Country	:	US
Telephone Number	:	404-352-2724
Fax Number	:

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/08/2007

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