Provider Demographics
NPI:1326145574
Name:GLOVER DRUGS JASPER LLC
Entity Type:Organization
Organization Name:GLOVER DRUGS JASPER LLC
Other - Org Name:SAM GLOVER DRUG
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:205-387-1481
Mailing Address - Street 1:408 18TH ST W
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-5346
Mailing Address - Country:US
Mailing Address - Phone:205-387-1481
Mailing Address - Fax:205-387-8744
Practice Address - Street 1:408 18TH ST W
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-5346
Practice Address - Country:US
Practice Address - Phone:205-387-1481
Practice Address - Fax:205-387-8744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL108630183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100002015Medicaid