Provider Demographics
NPI:1790388536
Name:GLEASON, JACQUELINE E (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:E
Last Name:GLEASON
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 1:363 LAKEVIEW ST
Mailing Address - Street 2:
Mailing Address - City:STEELE
Mailing Address - State:AL
Mailing Address - Zip Code:35987-2222
Mailing Address - Country:US
Mailing Address - Phone:256-390-4651
Mailing Address - Fax:
Practice Address - Street 1:1001 PELHAM RD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-3021
Practice Address - Country:US
Practice Address - Phone:256-435-2095
Practice Address - Fax:256-435-8774
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL14872OtherBOARD OF PHARMACY