Provider Demographics
NPI:1588929293
Name:GIBSON, JOHN JAMES (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JAMES
Last Name:GIBSON
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2036 VILLAGE GRN
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5478
Mailing Address - Country:US
Mailing Address - Phone:214-909-0291
Mailing Address - Fax:
Practice Address - Street 1:819 W ARAPAHO RD
Practice Address - Street 2:#57
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5045
Practice Address - Country:US
Practice Address - Phone:972-235-7133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX167501835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric