Provider Demographics
NPI:1154730893
Name:GIBSON, ERIANNE SIENA (PHARMD)
Entity type:Individual
Prefix:
First Name:ERIANNE
Middle Name:SIENA
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 40TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-6170
Mailing Address - Country:US
Mailing Address - Phone:218-359-4007
Mailing Address - Fax:218-359-4010
Practice Address - Street 1:950 40TH AVE S
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-6170
Practice Address - Country:US
Practice Address - Phone:218-359-4007
Practice Address - Fax:218-359-4010
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121948183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist