Healthcare Provider Details

I. General information

NPI: 1013547389
Provider Name (Legal Business Name): CRYSTAL GIBSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7685 MALL RD
FLORENCE KY
41042-1403
US

IV. Provider business mailing address

7685 MALL RD
FLORENCE KY
41042-1403
US

V. Phone/Fax

Practice location:
  • Phone: 859-795-5820
  • Fax:
Mailing address:
  • Phone: 859-795-5820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03236856
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number019312
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: