Provider Demographics
NPI:1487255246
Name:GLOVER, PAULETTE M (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PAULETTE
Middle Name:M
Last Name:GLOVER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 N RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3363
Mailing Address - Country:US
Mailing Address - Phone:410-418-9703
Mailing Address - Fax:410-418-9705
Practice Address - Street 1:3200 N RIDGE RD
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3363
Practice Address - Country:US
Practice Address - Phone:410-418-9703
Practice Address - Fax:410-418-9705
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15496183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist