Healthcare Provider Details

I. General information

NPI: 1881836054
Provider Name (Legal Business Name): JOHN WAYNE GLOVER JR. PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 S US HIGHWAY 27
HAVANA FL
32333-2018
US

IV. Provider business mailing address

704 S US HIGHWAY 27
HAVANA FL
32333-2018
US

V. Phone/Fax

Practice location:
  • Phone: 850-539-8080
  • Fax: 850-539-3050
Mailing address:
  • Phone: 850-539-8080
  • Fax: 850-539-3050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS 35790
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: