Provider Demographics
NPI:1851996466
Name:GIBSON, RYAN PHILLIP (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:PHILLIP
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 1:5231 FORSYTH PARK ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-6741
Mailing Address - Country:US
Mailing Address - Phone:804-832-8311
Mailing Address - Fax:
Practice Address - Street 1:8300 HEALTH PARK STE 227
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4731
Practice Address - Country:US
Practice Address - Phone:919-847-7645
Practice Address - Fax:919-847-7641
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202218080OtherDEPARTMENT OF HEALTH PROFESSIONS, COMMONWEALTH OF VIRGINIA