Provider Demographics
NPI:1447576277
Name:GLEATON, CARSON WILLIAMS (PHARMD)
Entity Type:Individual
Prefix:
First Name:CARSON
Middle Name:WILLIAMS
Last Name:GLEATON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W GORDON ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-3415
Mailing Address - Country:US
Mailing Address - Phone:706-647-8965
Mailing Address - Fax:706-647-4529
Practice Address - Street 1:500 W GORDON ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3415
Practice Address - Country:US
Practice Address - Phone:706-647-8965
Practice Address - Fax:706-647-4529
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist