Provider Demographics
NPI:1528019148
Name:GIBSON SALES LP
Entity Type:Organization
Organization Name:GIBSON SALES LP
Other - Org Name:DRUG EMPORIUM 210
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGLIOLO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:903-297-0766
Mailing Address - Street 1:PO BOX 6238
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75608-6238
Mailing Address - Country:US
Mailing Address - Phone:903-297-0766
Mailing Address - Fax:903-297-2895
Practice Address - Street 1:5819 E KINGS HWY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4303
Practice Address - Country:US
Practice Address - Phone:318-861-7898
Practice Address - Fax:903-297-2895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
LA1963RC3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1264440Medicaid
2032228OtherPK
5505670001Medicare NSC