Provider Demographics
NPI:1639745862
Name:GIBBS, SUZANNE LORRAINE (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:LORRAINE
Last Name:GIBBS
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3331 WOODLAND CT
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-5943
Mailing Address - Country:US
Mailing Address - Phone:248-821-5277
Mailing Address - Fax:
Practice Address - Street 1:6155 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:MI
Practice Address - Zip Code:48722-9618
Practice Address - Country:US
Practice Address - Phone:989-777-3550
Practice Address - Fax:989-777-5094
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303024239183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician