Provider Demographics
NPI:1518996420
Name:GIBBS PHARMACY INC
Entity Type:Organization
Organization Name:GIBBS PHARMACY INC
Other - Org Name:GIBBS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-449-3355
Mailing Address - Street 1:1427 W BADDOUR PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3062
Mailing Address - Country:US
Mailing Address - Phone:615-449-3355
Mailing Address - Fax:615-449-0083
Practice Address - Street 1:1427 W BADDOUR PKWY STE B
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3062
Practice Address - Country:US
Practice Address - Phone:615-449-3355
Practice Address - Fax:615-449-0083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WD0400X, 261QM2500X, 332B00000X, 333600000X, 3336C0004X, 3336L0003X
TN00000020733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2090844OtherPK
TN1454294Medicaid
4445380001Medicare NSC