Timothy Arthur Gleason, PHARM.D.
Individual provider Active NPI Pharmacist · Petersburg, IL
NPI 1669970984 · NPPES record last updated Feb 1, 2018
Key facts
- NPI
- 1669970984
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051295083 (IL)
- Practice address
- 200 S 6TH St
Petersburg, IL 62675-6267 - Phone
- (217) 632-2288
- Fax
- (217) 632-2033
- NPI assigned
- Feb 1, 2018
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051295083 | IL | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051295083 | IL | Yes |
Addresses
Primary practice location
200 S 6TH St
Petersburg, IL 62675-6267
Mailing address
321 N 8TH St
Petersburg, IL 62675-1219
Phone (217) 891-1449
Other providers in Petersburg, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 1, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.