Provider Demographics
NPI:1154836716
Name:CHRISTIE-GIBSON, TASHEIKA (PHARMD)
Entity Type:Individual
Prefix:
First Name:TASHEIKA
Middle Name:
Last Name:CHRISTIE-GIBSON
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 1:1010 KENILWORTH AVE APT 326
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3470
Mailing Address - Country:US
Mailing Address - Phone:832-243-2032
Mailing Address - Fax:
Practice Address - Street 1:731 SUTTERS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-8452
Practice Address - Country:US
Practice Address - Phone:252-937-9863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61937183500000X
NC27471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist