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General NPI Number Information
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NPI Number | 1669122503
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Entity Type | Individual
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Provider Name | WAYNE GIBSON RPH
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Gender | Male
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Dates
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Enumeration Date | 03/24/2022
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Last Update Date | 03/24/2022
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Provider Practice Location Address
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Address Line | 2918 N SAGINAW ST
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City | FLINT
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State | MI
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Zip | 48505-4452
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Country | US
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Telephone | 810-234-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 54 S BROADWAY ST APT 18
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City | LAKE ORION
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State | MI
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Zip | 48362-3191
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Country | US
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Telephone | 586-995-6660
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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 | 5402024362
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License Number State | MI
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