MEDICARE: GIBSON SALES LP

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	3336C0004X	Compounding Pharmacy
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	2096RC	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609827559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIBSON SALES LP

Provider Business Mailing Address
First Line	:	PO BOX 6238
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75608-6238
Country	:	US
Telephone Number	:	903-297-0766
Fax Number	:	903-297-2895

Provider Business Practice Location Address
First Line	:	505 BERTRAND DR
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70506-5542
Country	:	US
Telephone Number	:	337-261-0337
Fax Number	:	903-297-2895

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY
Name	:	RICHARD MAGILOLO
Credential	:	RPH
Telephone Number	:	903-297-0766

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	03/27/2026

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