Healthcare Provider Details

I. General information

NPI: 1356618508
Provider Name (Legal Business Name): DENISE LORRAINE GLEESON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 N MECHANIC ST
LEBANON OH
45036-1801
US

IV. Provider business mailing address

3747 S WAYNESVILLE RD
MORROW OH
45152-8216
US

V. Phone/Fax

Practice location:
  • Phone: 513-932-2911
  • Fax: 513-932-4905
Mailing address:
  • Phone: 513-899-4452
  • Fax: 513-932-4905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03321637
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: