Provider Demographics
NPI:1942700018
Name:GLEATON PHARMACY GROUP, LLC
Entity Type:Organization
Organization Name:GLEATON PHARMACY GROUP, LLC
Other - Org Name:FOCUS: MEDS PHARMACY AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISALYN
Authorized Official - Middle Name:K
Authorized Official - Last Name:GLEATON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:843-818-4638
Mailing Address - Street 1:2000 SAM RITTENBERG BLVD STE 134
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4629
Mailing Address - Country:US
Mailing Address - Phone:843-818-4638
Mailing Address - Fax:
Practice Address - Street 1:2000 SAM RITTENBERG BLVD STE 134
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4629
Practice Address - Country:US
Practice Address - Phone:843-818-4638
Practice Address - Fax:843-952-7157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC169753336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC716975Medicaid