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NPI Code Detail

MEDICARE: MARK W GIBSON

MEDICARE: MARK W 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
1183500000XPharmacist03310371OH

General Provider Information

NPI Number : 1417231465
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK W GIBSON
Provider Business Mailing Address
First Line : 1982 EIGHT MILE RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45255-2609
Country : US
Telephone Number : 513-474-4723
Fax Number :
Provider Business Practice Location Address
First Line : 1982 EIGHT MILE RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45255-2609
Country : US
Telephone Number : 513-474-4723
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2011
Last Update Date : 10/07/2011

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Directions to “ MARK W GIBSON ” Practice Location

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