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General NPI Number Information
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NPI Number | 1851388508
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Entity Type | Organization
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Legal Business Name | GIBSON DISCOUNT PHARMACY OF MARSHALL INC
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 03/12/2010
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Provider Practice Location Address
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Address Line | 110 E END BLVD N
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City | MARSHALL
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State | TX
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Zip | 75670-3602
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Country | US
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Telephone | 903-935-7775
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Fax | 903-938-3521
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Provider Business Mailing Address
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Address Line | 110 E END BLVD N
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City | MARSHALL
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State | TX
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Zip | 75670-3602
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Country | US
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Telephone | 903-935-7775
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Fax | 903-938-3521
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | JIM EASLEY
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Credential | RPH
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Telephone | 903-935-7775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 00352
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 00352
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License Number State | TX
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