Provider Demographics
NPI:1578056685
Name:GIBICH, ELIZABETH ANN MARIE
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN MARIE
Last Name:GIBICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANN MARIE
Other - Last Name:COCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 SPRINGBROOK RD
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-5356
Mailing Address - Country:US
Mailing Address - Phone:469-233-9264
Mailing Address - Fax:
Practice Address - Street 1:801 N INTERSTATE 35
Practice Address - Street 2:
Practice Address - City:BELLMEAD
Practice Address - State:TX
Practice Address - Zip Code:76705-2874
Practice Address - Country:US
Practice Address - Phone:254-799-0219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60864183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist