MEDICARE: DR. JAMES R GLASS II BPHARM

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	0202205188	VA

General Provider Information

NPI Number	:	1871744219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES R GLASS II BPHARM

Provider Business Mailing Address
First Line	:	5115 LEESBURG PIKE
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22041-3207
Country	:	US
Telephone Number	:	703-253-0022
Fax Number	:

Provider Business Practice Location Address
First Line	:	5115 LEESBURG PIKE
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22041-3207
Country	:	US
Telephone Number	:	703-253-0022
Fax Number	:

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

Provider Enumeration Date	:	10/03/2008
Last Update Date	:	10/03/2008

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