Provider Demographics
NPI:1114511060
Name:GIBBS, EMILY ANNA (PHARMD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANNA
Last Name:GIBBS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BOWDON
Mailing Address - State:GA
Mailing Address - Zip Code:30108-1309
Mailing Address - Country:US
Mailing Address - Phone:770-258-3366
Mailing Address - Fax:770-258-9840
Practice Address - Street 1:301 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BOWDON
Practice Address - State:GA
Practice Address - Zip Code:30108-1309
Practice Address - Country:US
Practice Address - Phone:770-258-3366
Practice Address - Fax:770-258-9840
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist