Provider Demographics
NPI:1235590076
Name:GIBBS, DANETTE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DANETTE
Middle Name:
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 1:101 S MARQUETTE RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU CHIEN
Mailing Address - State:WI
Mailing Address - Zip Code:53821-1639
Mailing Address - Country:US
Mailing Address - Phone:608-326-2581
Mailing Address - Fax:
Practice Address - Street 1:101 S MARQUETTE RD
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU CHIEN
Practice Address - State:WI
Practice Address - Zip Code:53821-1639
Practice Address - Country:US
Practice Address - Phone:608-326-2581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19707183500000X
WI13812-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist