Provider Demographics
NPI:1487793097
Name:LONG & GIBSON PHARMACY
Entity type:Organization
Organization Name:LONG & GIBSON PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-285-1711
Mailing Address - Street 1:303 EAST TICKLE STREET
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-3117
Mailing Address - Country:US
Mailing Address - Phone:731-285-1711
Mailing Address - Fax:731-285-2203
Practice Address - Street 1:303 EAST TICKLE STREET
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-3117
Practice Address - Country:US
Practice Address - Phone:731-285-1711
Practice Address - Fax:731-285-2203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1168580001Medicare NSC