Healthcare Provider Details

I. General information

NPI: 1962260117
Provider Name (Legal Business Name): GLEASON PHARMACY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3251 GINGER CREEK DR STE A
SPRINGFIELD IL
62711-7423
US

IV. Provider business mailing address

601 ROCK RIVER RD
SPRINGFIELD IL
62711-8338
US

V. Phone/Fax

Practice location:
  • Phone: 217-891-1449
  • Fax: 866-591-1654
Mailing address:
  • Phone: 217-891-1449
  • Fax:

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: TIMOTHY ARTHUR GLEASON
Title or Position: PRESIDENT
Credential:
Phone: 217-632-2288