Healthcare Provider Details

I. General information

NPI: 1144244450
Provider Name (Legal Business Name): KENNETH SAMUEL GLOVER II RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 MIDWAY PLAZA
DORA AL
35062
US

IV. Provider business mailing address

2371 HIGHWAY 78
DORA AL
35062-5233
US

V. Phone/Fax

Practice location:
  • Phone: 205-648-9918
  • Fax: 205-648-9644
Mailing address:
  • Phone: 205-648-9918
  • Fax: 205-648-9644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number105923
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: