Provider Demographics
NPI:1881836054
Name:GLOVER, JOHN WAYNE JR (PHARM D)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WAYNE
Last Name:GLOVER
Suffix:JR
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 1:704 S US HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:FL
Mailing Address - Zip Code:32333-2018
Mailing Address - Country:US
Mailing Address - Phone:850-539-8080
Mailing Address - Fax:850-539-3050
Practice Address - Street 1:704 S US HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:FL
Practice Address - Zip Code:32333-2018
Practice Address - Country:US
Practice Address - Phone:850-539-8080
Practice Address - Fax:850-539-3050
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 35790183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist