Provider Demographics
NPI:1558864462
Name:GIBBS, LESA ANN (RPH)
Entity Type:Individual
Prefix:MS
First Name:LESA
Middle Name:ANN
Last Name:GIBBS
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 1:1718 E LINCOLN RD # Q2120
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99217-7717
Mailing Address - Country:US
Mailing Address - Phone:509-262-4810
Mailing Address - Fax:
Practice Address - Street 1:1718 E LINCOLN RD # Q2120
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99217-7717
Practice Address - Country:US
Practice Address - Phone:509-262-4810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00014701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist