Provider Demographics
NPI:1528369758
Name:GLEEMAN, JONATHAN S (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:S
Last Name:GLEEMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E. CEDAR AVE.
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-1641
Mailing Address - Country:US
Mailing Address - Phone:928-774-3750
Mailing Address - Fax:928-774-2428
Practice Address - Street 1:1500 E. CEDAR AVE.
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1641
Practice Address - Country:US
Practice Address - Phone:928-774-3750
Practice Address - Fax:928-774-2428
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS012311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist