Organization
GLEASON PHARMACY SERVICES INC
Active
Other names
Potter Drug
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY GLEASON (OWNER/PRESIDENT/PIC/AO)
(217) 891-1449
Entity
Organization
Contact information
Practice address
214 ABE LINCOLN DR UNIT 2, ATHENS, IL 62613-7800
(217) 952-7030
(217) 952-7031
Mailing address
214 ABE LINCOLN DR UNIT 2, ATHENS, IL 62613-7800
(217) 891-1449
(217) 632-2033
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054.020373
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2174744
PK
—
Enumeration date
03/08/2017
Last updated
06/07/2018
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