Provider Demographics
NPI:1770105835
Name:GLOVER, ERIN REBECCA
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:REBECCA
Last Name:GLOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 WINDHAM LOOP
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35503-3252
Mailing Address - Country:US
Mailing Address - Phone:205-522-8162
Mailing Address - Fax:
Practice Address - Street 1:5558 CURRY HWY
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35503-5845
Practice Address - Country:US
Practice Address - Phone:205-221-6330
Practice Address - Fax:205-221-6332
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist