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General NPI Number Information
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NPI Number | 1366557613
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Entity Type | Individual
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Provider Name | JAMES BRIAN GIBBON RPH
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Gender | Male
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 07/20/2015
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Provider Practice Location Address
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Address Line | HIWAY 18 EAST
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City | PINE RIDGE
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State | SD
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Zip | 57770-1201
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Country | US
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Telephone | 605-867-3192
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Fax | 605-867-3279
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Provider Business Mailing Address
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Address Line | PO BOX 1201
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City | PINE RIDGE
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State | SD
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Zip | 57770-1201
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Country | US
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Telephone | 605-867-3192
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Fax | 605-867-3279
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 4442
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License Number State | ND
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