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General NPI Number Information
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NPI Number | 1114902608
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Entity Type | Organization
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Legal Business Name | GIBSON PHARMACY
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Dates
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Enumeration Date | 12/07/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3538 BROADWAY ST
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City | PEARLAND
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State | TX
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Zip | 77581-4307
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Country | US
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Telephone | 281-485-3282
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Fax | 281-485-3281
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Provider Business Mailing Address
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Address Line | 3538 BROADWAY ST
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City | PEARLAND
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State | TX
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Zip | 77581-4307
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Country | US
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Telephone | 281-485-3282
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Fax | 281-485-3281
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MARY HOANG TRAN
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Credential | R.PH.
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Telephone | 281-485-3282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 12485
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License Number State | TX
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