Provider Demographics
NPI:1669970984
Name:GLEASON, TIMOTHY ARTHUR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ARTHUR
Last Name:GLEASON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62675-1219
Mailing Address - Country:US
Mailing Address - Phone:217-891-1449
Mailing Address - Fax:
Practice Address - Street 1:200 S 6TH ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:IL
Practice Address - Zip Code:62675-6267
Practice Address - Country:US
Practice Address - Phone:217-632-2288
Practice Address - Fax:217-632-2033
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051295083183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist