Individual
DR. GLEN W DACE II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
1500 E WOODROW WILSON AVE, JACKSON, MS 39216-5116
(601) 364-1550
Mailing address
4019 GLENNOAK DR, JACKSON, MS 39272-9223
(601) 372-1821
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E-08709
MS
Other
Enumeration date
07/25/2006
Last updated
07/08/2007
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