Healthcare Provider Details

I. General information

NPI: 1952265530
Provider Name (Legal Business Name): LAUREL OLIVIA GIBSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15317 W 95TH ST
LENEXA KS
66219-1262
US

IV. Provider business mailing address

15317 W 95TH ST
LENEXA KS
66219-1262
US

V. Phone/Fax

Practice location:
  • Phone: 866-860-4179
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-122864
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: