Provider Demographics
NPI:1659855658
Name:RACHEL GIBSON INC.
Entity Type:Organization
Organization Name:RACHEL GIBSON INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-282-6231
Mailing Address - Street 1:1506 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RED BUD
Mailing Address - State:IL
Mailing Address - Zip Code:62278-1316
Mailing Address - Country:US
Mailing Address - Phone:618-282-6231
Mailing Address - Fax:618-282-4090
Practice Address - Street 1:1506 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RED BUD
Practice Address - State:IL
Practice Address - Zip Code:62278-1316
Practice Address - Country:US
Practice Address - Phone:618-282-6231
Practice Address - Fax:618-282-4090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy