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General NPI Number Information
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NPI Number | 1134231616
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Entity Type | Organization
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Legal Business Name | GRAHAM GIBSON'T PHY., INC.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 1005 HIGHWAY 16 S
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City | GRAHAM
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State | TX
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Zip | 76450-3835
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Country | US
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Telephone | 940-549-4600
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Fax | 940-549-4666
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Provider Business Mailing Address
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Address Line | PO BOX 1140
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City | GRAHAM
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State | TX
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Zip | 76450-1140
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Country | US
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Telephone | 940-549-4600
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Fax | 940-549-4666
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. LOWRY K. MAYO
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Credential | RPH
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Telephone | 940-549-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 03797
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | TX
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