MEDICARE: CALEB GIBSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	2017036377	MO

General Provider Information

NPI Number	:	1245182187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALEB GIBSON

Provider Business Mailing Address
First Line	:	1465 E GLENWOOD ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-3220
Country	:	US
Telephone Number	:	636-208-9367
Fax Number	:

Provider Business Practice Location Address
First Line	:	1235 E CHEROKEE ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-2203
Country	:	US
Telephone Number	:	417-820-2115
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/12/2026

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Directions to “ CALEB GIBSON ” Practice Location

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