MEDICARE: DANETTE GIBBS PHARMD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	19707	IA
2	183500000X	Pharmacist	13812-040	WI

General Provider Information

NPI Number	:	1235590076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANETTE GIBBS PHARMD.

Provider Business Mailing Address
First Line	:	101 S MARQUETTE RD
Second Line	:
City	:	PRAIRIE DU CHIEN
State	:	WI
Zip	:	53821-1639
Country	:	US
Telephone Number	:	608-326-2581
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 S MARQUETTE RD
Second Line	:
City	:	PRAIRIE DU CHIEN
State	:	WI
Zip	:	53821-1639
Country	:	US
Telephone Number	:	608-326-2581
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2016
Last Update Date	:	03/07/2016

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