Provider Demographics
NPI:1003105818
Name:GIPSON, PATRICIA J (DPH)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:J
Last Name:GIPSON
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 WEST MAIN STREET SUITE A
Mailing Address - Street 2:KROGER PHARMACY
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3264
Mailing Address - Country:US
Mailing Address - Phone:615-449-4653
Mailing Address - Fax:615-449-8873
Practice Address - Street 1:1418 WEST MAIN STREET SUITE A
Practice Address - Street 2:KROGER PHARMACY
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3264
Practice Address - Country:US
Practice Address - Phone:615-449-4653
Practice Address - Fax:615-449-8873
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6067183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist