Healthcare Provider Details

I. General information

NPI: 1730293556
Provider Name (Legal Business Name): RICHARD A GIBBONS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 NORTH AVE
GRAND JCT CO
81501-6428
US

IV. Provider business mailing address

3058 NOBLE CT
GRAND JUNCTION CO
81504-6983
US

V. Phone/Fax

Practice location:
  • Phone: 970-263-2800
  • Fax:
Mailing address:
  • Phone: 970-434-7682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14677
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: