Healthcare Provider Details

I. General information

NPI: 1598145724
Provider Name (Legal Business Name): GLEASON PHARMACY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S 6TH ST
PETERSBURG IL
62675-1553
US

IV. Provider business mailing address

200 S 6TH ST
PETERSBURG IL
62675-1553
US

V. Phone/Fax

Practice location:
  • Phone: 217-632-2287
  • Fax: 217-632-2033
Mailing address:
  • Phone: 217-632-2287
  • Fax: 217-632-2033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY A GLEASON
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 217-632-2287