Provider Demographics
NPI:1598145724
Name:GLEASON PHARMACY SERVICES INC
Entity type:Organization
Organization Name:GLEASON PHARMACY SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GLEASON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:217-632-2287
Mailing Address - Street 1:200 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62675-1553
Mailing Address - Country:US
Mailing Address - Phone:217-632-2287
Mailing Address - Fax:217-632-2033
Practice Address - Street 1:200 S 6TH ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:IL
Practice Address - Zip Code:62675-1553
Practice Address - Country:US
Practice Address - Phone:217-632-2287
Practice Address - Fax:217-632-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7569350001Medicare NSC