MEDICARE: DR. PHEOPHILUS H GLOVER PHARM.D.

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		IL

General Provider Information

NPI Number	:	1669472197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHEOPHILUS H GLOVER PHARM.D.

Provider Business Mailing Address
First Line	:	5948 N PAULINA ST
Second Line	:	#2
City	:	CHICAGO
State	:	IL
Zip	:	60660-3210
Country	:	US
Telephone Number	:	773-334-3647
Fax Number	:	773-334-7818

Provider Business Practice Location Address
First Line	:	5948 N PAULINA ST
Second Line	:	#2
City	:	CHICAGO
State	:	IL
Zip	:	60660-3210
Country	:	US
Telephone Number	:	773-334-3647
Fax Number	:	773-334-7818

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

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	07/08/2007

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