MEDICARE: MS. HOLLY GIBSON PHARMD

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	16877	AL

General Provider Information

NPI Number	:	1245511062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HOLLY GIBSON PHARMD

Provider Business Mailing Address
First Line	:	5086 HIGHWAY 84 WEST
Second Line	:
City	:	FRISCO CITY
State	:	AL
Zip	:	36445
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 NORTH CRAFT HIGHWAY
Second Line	:
City	:	CHICKASAW
State	:	AL
Zip	:	36611
Country	:	US
Telephone Number	:	251-452-0531
Fax Number	:

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

Provider Enumeration Date	:	09/07/2011
Last Update Date	:	09/07/2011

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Directions to “ MS. HOLLY GIBSON PHARMD” Practice Location

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