Healthcare Provider Details

I. General information

NPI: 1245182187
Provider Name (Legal Business Name): CALEB GIBSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 E CHEROKEE ST
SPRINGFIELD MO
65804-2203
US

IV. Provider business mailing address

1465 E GLENWOOD ST
SPRINGFIELD MO
65804-3220
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-2115
  • Fax:
Mailing address:
  • Phone: 636-208-9367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2017036377
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: