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General NPI Number Information
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NPI Number | 1245182187
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Entity Type | Individual
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Provider Name | CALEB GIBSON
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Gender | Male
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Dates
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Enumeration Date | 02/12/2026
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 1235 E CHEROKEE ST
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City | SPRINGFIELD
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State | MO
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Zip | 65804-2203
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Country | US
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Telephone | 417-820-2115
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Fax |
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Provider Business Mailing Address
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Address Line | 1465 E GLENWOOD ST
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City | SPRINGFIELD
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State | MO
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Zip | 65804-3220
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Country | US
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Telephone | 636-208-9367
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2017036377
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License Number State | MO
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