Provider Demographics
NPI:1568716256
Name:GIBBONS, TERRI LYNNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:LYNNE
Last Name:GIBBONS
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 1:16690 ROYALTON RD
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-4433
Mailing Address - Country:US
Mailing Address - Phone:440-783-3424
Mailing Address - Fax:
Practice Address - Street 1:16690 ROYALTON RD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-4433
Practice Address - Country:US
Practice Address - Phone:440-783-3424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03313328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist