Provider Demographics
NPI:1316655517
Name:GIBBLE, MILINDA MARIE
Entity type:Individual
Prefix:
First Name:MILINDA
Middle Name:MARIE
Last Name:GIBBLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23319 CEDAR WAY APT K201
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-4345
Mailing Address - Country:US
Mailing Address - Phone:570-728-0463
Mailing Address - Fax:
Practice Address - Street 1:23028 100TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-5080
Practice Address - Country:US
Practice Address - Phone:425-670-2860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA61353595183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician