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General NPI Number Information
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NPI Number | 1821531062
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Entity Type | Organization
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Legal Business Name | GLEATON PHARMACY GROUP
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Dates
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Enumeration Date | 11/21/2016
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 2000 SAM RITTENBERG BLVD STE 134
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City | CHARLESTON
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State | SC
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Zip | 29407-4629
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Country | US
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Telephone | 843-818-4638
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Fax | 843-952-7157
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Provider Business Mailing Address
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Address Line | PO BOX 30866
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City | CHARLESTON
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State | SC
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Zip | 29417-0866
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Country | US
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Telephone | 843-818-4638
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Fax | 843-952-7157
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Authorized Official
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Title or Position | OWNER
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Name | KRISALYN GLEATON
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Credential | PHARMD
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Telephone | 843-991-8403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 16975
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License Number State | SC
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