Provider Demographics
NPI:1487983300
Name:GLOVER DRUG URGENT CARE NW
Entity type:Organization
Organization Name:GLOVER DRUG URGENT CARE NW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:205-387-2269
Mailing Address - Street 1:2708 HIGHWAY 78 E
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-3430
Mailing Address - Country:US
Mailing Address - Phone:205-387-2253
Mailing Address - Fax:205-387-2269
Practice Address - Street 1:2708 HIGHWAY 78 E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-3430
Practice Address - Country:US
Practice Address - Phone:205-387-2253
Practice Address - Fax:205-387-2269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy