Healthcare Provider Details

I. General information

NPI: 1245160845
Provider Name (Legal Business Name): JAMIE GLEASON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5305 S 1900 W
ROY UT
84067-2906
US

IV. Provider business mailing address

5935 CASSIE DR
OGDEN UT
84405-4925
US

V. Phone/Fax

Practice location:
  • Phone: 801-825-5648
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number338606-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: