Healthcare Provider Details

I. General information

NPI: 1487983300
Provider Name (Legal Business Name): GLOVER DRUG URGENT CARE NW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2009
Last Update Date: 12/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 HIGHWAY 78 E
JASPER AL
35501-3430
US

IV. Provider business mailing address

2708 HIGHWAY 78 E
JASPER AL
35501-3430
US

V. Phone/Fax

Practice location:
  • Phone: 205-387-2253
  • Fax: 205-387-2269
Mailing address:
  • Phone: 205-387-2253
  • Fax: 205-387-2269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateAL

VIII. Authorized Official

Name: MR. KENNETH SAMUEL GLOVER II
Title or Position: PARTNER
Credential:
Phone: 205-387-2269