Provider Demographics
NPI:1588030811
Name:GLEASON, WILLIAM M (RPH)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:GLEASON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 OVERCREEK WAY
Mailing Address - Street 2:
Mailing Address - City:SEALY
Mailing Address - State:TX
Mailing Address - Zip Code:77474-3799
Mailing Address - Country:US
Mailing Address - Phone:979-627-0102
Mailing Address - Fax:979-627-0104
Practice Address - Street 1:310 OVERCREEK WAY
Practice Address - Street 2:
Practice Address - City:SEALY
Practice Address - State:TX
Practice Address - Zip Code:77474-3799
Practice Address - Country:US
Practice Address - Phone:979-627-0102
Practice Address - Fax:979-627-0104
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12152183500000X
TX22152183500000X
LA017039183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist