MEDICARE: DR. PAULETTE M GLOVER PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	15496	MD

General Provider Information

NPI Number	:	1487255246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAULETTE M GLOVER PHARMD

Provider Business Mailing Address
First Line	:	3200 N RIDGE RD
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-3363
Country	:	US
Telephone Number	:	410-418-9703
Fax Number	:	410-418-9705

Provider Business Practice Location Address
First Line	:	3200 N RIDGE RD
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-3363
Country	:	US
Telephone Number	:	410-418-9703
Fax Number	:	410-418-9705

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2020
Last Update Date	:	11/06/2020

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