Healthcare Provider Details

I. General information

NPI: 1922094499
Provider Name (Legal Business Name): KIMBERLY RENEE GIBBONS PHARM D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W COMMERCIAL ST
OZARK AR
72949-3112
US

IV. Provider business mailing address

5203 S HIGHWAY 23
OZARK AR
72949-8284
US

V. Phone/Fax

Practice location:
  • Phone: 479-667-2101
  • Fax: 479-667-1270
Mailing address:
  • Phone: 479-667-1549
  • Fax: 479-667-1270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number09096
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: