Provider Demographics
NPI:1558690438
Name:GIBSON, CHARMAINE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CHARMAINE
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 W PLEASANT RUN RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-1213
Mailing Address - Country:US
Mailing Address - Phone:972-218-6446
Mailing Address - Fax:972-218-6893
Practice Address - Street 1:1507 W PLEASANT RUN RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1213
Practice Address - Country:US
Practice Address - Phone:972-218-6446
Practice Address - Fax:972-218-6893
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44182183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist