Healthcare Provider Details

I. General information

NPI: 1962845826
Provider Name (Legal Business Name): ROBERT JOSEPH GIBBONS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 HIGHWAY 133
CARBONDALE CO
81623-1874
US

IV. Provider business mailing address

1051 HIGHWAY 133
CARBONDALE CO
81623-1874
US

V. Phone/Fax

Practice location:
  • Phone: 970-963-5727
  • Fax: 970-963-8578
Mailing address:
  • Phone: 970-963-5727
  • Fax: 970-963-8578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11289
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: