Provider Demographics
NPI:1356618508
Name:GLEESON, DENISE LORRAINE (RPH)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:LORRAINE
Last Name:GLEESON
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 1:3747 S WAYNESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:OH
Mailing Address - Zip Code:45152-8216
Mailing Address - Country:US
Mailing Address - Phone:513-899-4452
Mailing Address - Fax:513-932-4905
Practice Address - Street 1:19 N MECHANIC ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1801
Practice Address - Country:US
Practice Address - Phone:513-932-2911
Practice Address - Fax:513-932-4905
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03321637183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist