Provider Demographics
NPI:1457628067
Name:GIBSON, DEMETRIA RENEE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DEMETRIA
Middle Name:RENEE
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 1:1129 SPLASHING BROOK DR
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-3065
Mailing Address - Country:US
Mailing Address - Phone:410-676-8747
Mailing Address - Fax:
Practice Address - Street 1:1129 SPLASHING BROOK DR
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-3065
Practice Address - Country:US
Practice Address - Phone:410-676-8747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist