Provider Demographics
NPI:1922392711
Name:RASSAS, GLEN A (RPH)
Entity type:Individual
Prefix:MR
First Name:GLEN
Middle Name:A
Last Name:RASSAS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-5111
Mailing Address - Country:US
Mailing Address - Phone:732-222-2932
Mailing Address - Fax:
Practice Address - Street 1:2175 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1009
Practice Address - Country:US
Practice Address - Phone:732-974-2929
Practice Address - Fax:732-974-2644
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01830600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist