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NPI Code Detail

MEDICARE: DEVENI GIBSON

MEDICARE: DEVENI 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
1183500000XPharmacist64833FL

General Provider Information

NPI Number : 1679296123
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEVENI GIBSON
Provider Business Mailing Address
First Line : 12145 SAN JOSE BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32223-2636
Country : US
Telephone Number : 904-262-6808
Fax Number :
Provider Business Practice Location Address
First Line : 12145 SAN JOSE BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32223-2636
Country : US
Telephone Number : 904-262-6808
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2022
Last Update Date : 09/20/2022

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Directions to “ DEVENI GIBSON ” Practice Location

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