Healthcare Provider Details

I. General information

NPI: 1366773467
Provider Name (Legal Business Name): LINDA LEE GLEESON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2010
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73265 CONFEDERATED WAY
PENDLETON OR
97801
US

IV. Provider business mailing address

307 C AVE
LA GRANDE OR
97850-1136
US

V. Phone/Fax

Practice location:
  • Phone: 541-278-7505
  • Fax: 541-278-7572
Mailing address:
  • Phone: 541-963-0496
  • Fax: 541-963-0278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH0006700
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: