Provider Demographics
NPI:1710367750
Name:GLEADELL, DEBRA LEE (RPH)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:LEE
Last Name:GLEADELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-4133
Mailing Address - Country:US
Mailing Address - Phone:937-878-6022
Mailing Address - Fax:
Practice Address - Street 1:1400 WEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-4133
Practice Address - Country:US
Practice Address - Phone:937-878-6022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03224942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist