Provider Demographics
NPI:1528409901
Name:GIBSON, KRISTEN L (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:L
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 PALM COAST PKWY NE UNIT 1000
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8286
Mailing Address - Country:US
Mailing Address - Phone:386-597-4781
Mailing Address - Fax:
Practice Address - Street 1:250 PALM COAST PKWY NE UNIT 1000
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8286
Practice Address - Country:US
Practice Address - Phone:386-597-4781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist