MEDICARE: GLEASON PHARMACY SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1598145724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLEASON PHARMACY SERVICES INC

Provider Business Mailing Address
First Line	:	200 S 6TH ST
Second Line	:
City	:	PETERSBURG
State	:	IL
Zip	:	62675-1553
Country	:	US
Telephone Number	:	217-632-2287
Fax Number	:	217-632-2033

Provider Business Practice Location Address
First Line	:	200 S 6TH ST
Second Line	:
City	:	PETERSBURG
State	:	IL
Zip	:	62675-1553
Country	:	US
Telephone Number	:	217-632-2287
Fax Number	:	217-632-2033

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TIMOTHY A GLEASON
Credential	:	PHARMD
Telephone Number	:	217-632-2287

Provider Enumeration Date	:	06/03/2015
Last Update Date	:	01/05/2017

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Directions to “GLEASON PHARMACY SERVICES INC ” Practice Location

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