Provider Demographics
NPI:1407374234
Name:GIBSON, ERIC ASHLEY (RPH)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ASHLEY
Last Name:GIBSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10405 LIONS HEART
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80124-9529
Mailing Address - Country:US
Mailing Address - Phone:615-613-4828
Mailing Address - Fax:
Practice Address - Street 1:10405 LIONS HEART
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80124-9529
Practice Address - Country:US
Practice Address - Phone:615-613-4828
Practice Address - Fax:615-613-4828
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28581183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE