Healthcare Provider Details

I. General information

NPI: 1902319510
Provider Name (Legal Business Name): GLEASON PHARMACY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 11/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 S STATE ST
ROCHESTER IL
62563-9297
US

IV. Provider business mailing address

441 S STATE ST
ROCHESTER IL
62563-9297
US

V. Phone/Fax

Practice location:
  • Phone: 217-891-1449
  • Fax:
Mailing address:
  • Phone: 217-891-1449
  • 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 ARTHUR GLEASON
Title or Position: PRESIDENT
Credential: PHARM.D.
Phone: 217-632-2288