Healthcare Provider Details

I. General information

NPI: 1316853658
Provider Name (Legal Business Name): GREGORY DARRYL GIBSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 SKYLINE DR
JACKSON TN
38301-3923
US

IV. Provider business mailing address

1680 N HIGHLAND AVE
JACKSON TN
38301-3460
US

V. Phone/Fax

Practice location:
  • Phone: 731-541-2092
  • Fax:
Mailing address:
  • Phone: 731-541-2092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number7837
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: