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General NPI Number Information
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NPI Number | 1376888065
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Entity Type | Individual
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Provider Name | JAMES H GIBSON III PHARM,D.
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Gender | Male
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Dates
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Enumeration Date | 12/06/2012
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Last Update Date | 12/06/2012
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Provider Practice Location Address
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Address Line | 3118 CEDAR VALLEY DR
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City | RICHLANDS
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State | VA
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Zip | 24641-3075
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Country | US
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Telephone | 276-964-2494
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 84
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City | CEDAR BLUFF
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State | VA
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Zip | 24609-0084
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Country | US
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Telephone |
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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 | 0202012624
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License Number State | VA
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