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General NPI Number Information
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NPI Number | 1639241144
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Entity Type | Organization
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Legal Business Name | GIBSONBURG PHARMACY INC
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 03/08/2017
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Provider Practice Location Address
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Address Line | 350 RICE ST
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City | ELMORE
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State | OH
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Zip | 43416
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Country | US
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Telephone | 419-862-2982
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Fax | 419-862-9006
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Provider Business Mailing Address
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Address Line | PO BOX 11
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City | ELMORE
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State | OH
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Zip | 43416-0011
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Country | US
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Telephone | 419-862-2982
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Fax |
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Authorized Official
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Title or Position | OWNER AND PRES
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Name | MICHAEL WARREN
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Credential |
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Telephone | 419-637-7441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 020455650
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License Number State | OH
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