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General NPI Number Information
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NPI Number | 1588205652
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Entity Type | Individual
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Provider Name | LAURIE CHRISTINE GLEASON PHARMACIST
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Gender | Female
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Dates
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Enumeration Date | 09/30/2019
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Last Update Date | 09/30/2019
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Provider Practice Location Address
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Address Line | 2111 CLAUDE BAILEY PKWY
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City | PRINCETON
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State | IL
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Zip | 61356-8618
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Country | US
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Telephone | 815-875-4551
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Fax | 815-875-8022
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Provider Business Mailing Address
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Address Line | 1215 BLUE SPRUCE DR
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City | PRINCETON
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State | IL
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Zip | 61356-2896
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Country | US
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Telephone | 815-441-3323
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051037068
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License Number State | IL
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