Healthcare Provider Details

I. General information

NPI: 1437690567
Provider Name (Legal Business Name): GLEASON PHARMACY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2017
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 ABE LINCOLN DR UNIT 2
ATHENS IL
62613-7800
US

IV. Provider business mailing address

214 ABE LINCOLN DR UNIT 2
ATHENS IL
62613-7800
US

V. Phone/Fax

Practice location:
  • Phone: 217-952-7030
  • Fax: 217-952-7031
Mailing address:
  • Phone: 217-891-1449
  • Fax: 217-632-2033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054.020373
License Number StateIL

VIII. Authorized Official

Name: TIMOTHY GLEASON
Title or Position: OWNER/PRESIDENT/PIC/AO
Credential:
Phone: 217-891-1449