Provider Demographics
NPI:1346571106
Name:GIBSONS PHARMACY OF CRAIGHEAD COUNTY INC
Entity Type:Organization
Organization Name:GIBSONS PHARMACY OF CRAIGHEAD COUNTY INC
Other - Org Name:GIBSON'S PHARMACY OF JONESBORO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-793-3999
Mailing Address - Street 1:1595 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7222
Mailing Address - Country:US
Mailing Address - Phone:870-793-4179
Mailing Address - Fax:870-793-7303
Practice Address - Street 1:403 E MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3142
Practice Address - Country:US
Practice Address - Phone:870-972-1333
Practice Address - Fax:870-972-1624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR20624333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2123107OtherPK