Provider Demographics
NPI:1518274901
Name:GIBBONS, PAIGE S (RPH)
Entity Type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:S
Last Name:GIBBONS
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 1:975 BACONS BRIDGE RD
Mailing Address - Street 2:BILO PHARMACY #228
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485
Mailing Address - Country:US
Mailing Address - Phone:843-871-0473
Mailing Address - Fax:843-871-3338
Practice Address - Street 1:975 BACONS BRIDGE RD
Practice Address - Street 2:BILO PHARMACY #228
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485
Practice Address - Country:US
Practice Address - Phone:843-871-0473
Practice Address - Fax:843-871-3338
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC9923183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist