Provider Demographics
NPI:1669472197
Name:GLOVER, PHEOPHILUS H (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PHEOPHILUS
Middle Name:H
Last Name:GLOVER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5948 N PAULINA ST
Mailing Address - Street 2:#2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3210
Mailing Address - Country:US
Mailing Address - Phone:773-334-3647
Mailing Address - Fax:773-334-7818
Practice Address - Street 1:5948 N PAULINA ST
Practice Address - Street 2:#2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-3210
Practice Address - Country:US
Practice Address - Phone:773-334-3647
Practice Address - Fax:773-334-7818
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist