Provider Demographics
NPI:1386156271
Name:GIBSON, DALTON (PHARMD)
Entity type:Individual
Prefix:
First Name:DALTON
Middle Name:
Last Name:GIBSON
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 1:3232 TRI CITY DR
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73065-6324
Mailing Address - Country:US
Mailing Address - Phone:405-387-5006
Mailing Address - Fax:405-387-5092
Practice Address - Street 1:3232 TRI CITY DR
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:OK
Practice Address - Zip Code:73065-6324
Practice Address - Country:US
Practice Address - Phone:405-387-5006
Practice Address - Fax:405-387-5092
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17536183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist