=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194126243
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AARON GIBSON PHARM.D., M.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2014
-----------------------------------------------------
Last Update Date | 09/09/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 813 HOSPITAL DR
-----------------------------------------------------
City | ANDREWS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79714-3618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-523-4861
-----------------------------------------------------
Fax | 432-524-4418
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 813 HOSPITAL DR
-----------------------------------------------------
City | ANDREWS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79714-3618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-523-4861
-----------------------------------------------------
Fax | 432-524-4418
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 42647
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------