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General NPI Number Information
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NPI Number | 1790388536
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Entity Type | Individual
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Provider Name | JACQUELINE E GLEASON PHARMD
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Gender | Female
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Dates
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Enumeration Date | 11/16/2020
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Last Update Date | 11/16/2020
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Provider Practice Location Address
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Address Line | 1001 PELHAM RD S
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City | JACKSONVILLE
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State | AL
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Zip | 36265-3021
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Country | US
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Telephone | 256-435-2095
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Fax | 256-435-8774
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Provider Business Mailing Address
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Address Line | 363 LAKEVIEW ST
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City | STEELE
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State | AL
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Zip | 35987-2222
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Country | US
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Telephone | 256-390-4651
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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 | 14872
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License Number State | AL
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