MEDICARE: MATTHEW WAYNE GIBBS R.PH.

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	30470	TX

General Provider Information

NPI Number	:	1497262836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW WAYNE GIBBS R.PH.

Provider Business Mailing Address
First Line	:	7004 WHISPERING CREEK DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78736-1935
Country	:	US
Telephone Number	:	512-484-4915
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 W 38TH ST STE 403
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78705-1013
Country	:	US
Telephone Number	:	512-459-0639
Fax Number	:	512-459-3319

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

Provider Enumeration Date	:	01/08/2018
Last Update Date	:	01/08/2018

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