Provider Demographics
NPI:1194371872
Name:GLOVER, ADAM J (PHARM, D)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:J
Last Name:GLOVER
Suffix:
Gender:M
Credentials:PHARM, D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 FINKS HIDEAWAY RD APT 161
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2468
Mailing Address - Country:US
Mailing Address - Phone:225-384-4456
Mailing Address - Fax:
Practice Address - Street 1:3555 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71109-5209
Practice Address - Country:US
Practice Address - Phone:318-525-0144
Practice Address - Fax:318-525-0222
Is Sole Proprietor?:No
Enumeration Date:2019-08-17
Last Update Date:2019-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.023154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist