Provider Demographics
NPI:1205858255
Name:JULIAN D. MADDOX INC. DBA GLOVER PHARMACY
Entity Type:Organization
Organization Name:JULIAN D. MADDOX INC. DBA GLOVER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-483-9233
Mailing Address - Street 1:100 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:AL
Mailing Address - Zip Code:35550-1413
Mailing Address - Country:US
Mailing Address - Phone:205-483-9233
Mailing Address - Fax:
Practice Address - Street 1:100 MAIN ST
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:AL
Practice Address - Zip Code:35550-1413
Practice Address - Country:US
Practice Address - Phone:205-483-9233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL104617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100001767Medicaid