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General NPI Number Information
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NPI Number | 1669970984
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Entity Type | Individual
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Provider Name | TIMOTHY ARTHUR GLEASON PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 02/01/2018
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Last Update Date | 02/01/2018
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Provider Practice Location Address
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Address Line | 200 S 6TH ST
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City | PETERSBURG
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State | IL
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Zip | 62675-6267
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Country | US
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Telephone | 217-632-2288
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Fax | 217-632-2033
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Provider Business Mailing Address
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Address Line | 321 N 8TH ST
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City | PETERSBURG
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State | IL
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Zip | 62675-1219
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Country | US
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Telephone | 217-891-1449
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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 | 051295083
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License Number State | IL
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