Provider Demographics
NPI:1760104434
Name:GLEATON, K.C.
Entity Type:Individual
Prefix:
First Name:K.C.
Middle Name:
Last Name:GLEATON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2851 JESSUP RD UNIT 932
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:MD
Mailing Address - Zip Code:20794-7545
Mailing Address - Country:US
Mailing Address - Phone:973-510-2100
Mailing Address - Fax:
Practice Address - Street 1:10320 LITTLE PATUXENT PKWY STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3344
Practice Address - Country:US
Practice Address - Phone:973-510-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No171W00000XOther Service ProvidersContractor
No332900000XSuppliersNon-Pharmacy Dispensing Site
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy