Provider Demographics
NPI:1407411531
Name:GIBSON, KATHRYN WELDON (RPH)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:WELDON
Last Name:GIBSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3251 REVERE ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-1856
Mailing Address - Country:US
Mailing Address - Phone:720-381-3737
Mailing Address - Fax:
Practice Address - Street 1:3251 REVERE ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-1856
Practice Address - Country:US
Practice Address - Phone:720-381-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0022622183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist