Provider Demographics
NPI:1336476720
Name:GIBSON, DONALD RAYE II (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:RAYE
Last Name:GIBSON
Suffix:II
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4560 WINDING WOOD TRL
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3925
Mailing Address - Country:US
Mailing Address - Phone:405-323-0495
Mailing Address - Fax:
Practice Address - Street 1:13022 PRESTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-5202
Practice Address - Country:US
Practice Address - Phone:972-386-4649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47949183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist