Provider Demographics
NPI:1568804458
Name:GIBBS, JACOB LEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:LEE
Last Name:GIBBS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 ISLAND FORD RD STE D
Mailing Address - Street 2:
Mailing Address - City:MAIDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28650-8733
Mailing Address - Country:US
Mailing Address - Phone:828-428-0668
Mailing Address - Fax:828-428-3303
Practice Address - Street 1:201 ISLAND FORD RD STE D
Practice Address - Street 2:
Practice Address - City:MAIDEN
Practice Address - State:NC
Practice Address - Zip Code:28650-8733
Practice Address - Country:US
Practice Address - Phone:828-428-0668
Practice Address - Fax:828-428-3303
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23523183500000X
SC14252183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist