Provider Demographics
NPI:1851542526
Name:GLEASON, MARY LOUISE (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LOUISE
Last Name:GLEASON
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 1:5447 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6647
Mailing Address - Country:US
Mailing Address - Phone:716-632-8608
Mailing Address - Fax:716-632-8689
Practice Address - Street 1:5447 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6647
Practice Address - Country:US
Practice Address - Phone:716-632-8608
Practice Address - Fax:716-632-8689
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049015-1183500000X
FLPS59089183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist