Provider Demographics
NPI:1619565256
Name:GIBSON, KIRK E (CPHT)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:E
Last Name:GIBSON
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 WICKLOW DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-9036
Mailing Address - Country:US
Mailing Address - Phone:717-779-0618
Mailing Address - Fax:
Practice Address - Street 1:1800 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-8506
Practice Address - Country:US
Practice Address - Phone:717-767-7009
Practice Address - Fax:717-767-0774
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA360101060752498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist