Healthcare Provider Details

I. General information

NPI: 1609827302
Provider Name (Legal Business Name): GIBSON SALES LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9112 N RODNEY PARHAM RD STE 110
LITTLE ROCK AR
72205-1648
US

IV. Provider business mailing address

PO BOX 6238
LONGVIEW TX
75608-6238
US

V. Phone/Fax

Practice location:
  • Phone: 501-223-2262
  • Fax: 903-297-2895
Mailing address:
  • Phone: 903-297-0766
  • Fax: 903-297-2895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR20349
License Number StateAR

VIII. Authorized Official

Name: RICHARD MAGLIOLO
Title or Position: DIRECTOR OF PHARMACY
Credential: RPH
Phone: 903-297-0766