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General NPI Number Information
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NPI Number | 1679563480
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Entity Type | Individual
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Provider Name | JILL CAROLYN GIBSON R.PH.
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Gender | Female
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Dates
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Enumeration Date | 10/24/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 202 N BROADWAY
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City | ROCHESTER
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State | MN
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Zip | 55906-3646
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Country | US
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Telephone | 507-288-6463
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Fax |
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Provider Business Mailing Address
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Address Line | 803 9TH AVE NW
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City | BYRON
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State | MN
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Zip | 55920-1571
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Country | US
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Telephone | 507-775-2629
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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 | 115460-9
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License Number State | MN
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