MEDICARE: GLENDON EARL GRAVLEE

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	9125	AL

General Provider Information

NPI Number	:	1528118932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENDON EARL GRAVLEE

Provider Business Mailing Address
First Line	:	2408 WOODLEY DR
Second Line	:
City	:	JASPER
State	:	AL
Zip	:	35504-9456
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6456 AL HWY 269
Second Line	:
City	:	PARRISH
State	:	AL
Zip	:	35580
Country	:	US
Telephone Number	:	205-648-9945
Fax Number	:	205-648-9993

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	01/11/2012

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Directions to “ GLENDON EARL GRAVLEE ” Practice Location

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