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General NPI Number Information
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NPI Number | 1548367774
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Entity Type | Organization
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Legal Business Name | KENNETH SAMUEL GLOVER II
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 02/23/2023
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Provider Practice Location Address
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Address Line | 27 MIDWAY PLAZA
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City | DORA
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State | AL
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Zip | 35062
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Country | US
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Telephone | 205-648-9918
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Fax | 205-648-9644
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Provider Business Mailing Address
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Address Line | 2371 HWY 78
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City | DORA
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State | AL
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Zip | 35062
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KENNETH SAMUEL GLOVER II
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Credential | RPH
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Telephone | 205-648-9918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 105923
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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