Provider Demographics
NPI:1275576688
Name:GIBSON, AMY E (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:E
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 WOODSPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-0903
Mailing Address - Country:US
Mailing Address - Phone:870-972-8310
Mailing Address - Fax:
Practice Address - Street 1:1807 WOODSPRINGS RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-0903
Practice Address - Country:US
Practice Address - Phone:870-972-8310
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR9941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0410732OtherWOODSPRINGS PHARMACY
AR0544720001Medicare ID - Type UnspecifiedHOME HEALTH