Provider Demographics
NPI:1467977348
Name:BIBBY, JOEL THOMAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:THOMAS
Last Name:BIBBY
Suffix:
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 1:8464 MOSSY CUP TRL
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-5627
Mailing Address - Country:US
Mailing Address - Phone:503-752-3484
Mailing Address - Fax:
Practice Address - Street 1:508 HIGHWAY 29 N
Practice Address - Street 2:
Practice Address - City:CHINA GROVE
Practice Address - State:NC
Practice Address - Zip Code:28023
Practice Address - Country:US
Practice Address - Phone:704-857-0116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27271183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist