MEDICARE: NANCY E GIBSON RPH

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	042725	MO

General Provider Information

NPI Number	:	1487960324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY E GIBSON RPH

Provider Business Mailing Address
First Line	:	5201 CHIPPEWA ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-2355
Country	:	US
Telephone Number	:	314-352-5201
Fax Number	:

Provider Business Practice Location Address
First Line	:	5201 CHIPPEWA ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-2355
Country	:	US
Telephone Number	:	314-352-5201
Fax Number	:

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

Provider Enumeration Date	:	08/30/2010
Last Update Date	:	08/30/2010

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Directions to “ NANCY E GIBSON RPH” Practice Location

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