Provider Demographics
NPI:1679563480
Name:GIBSON, JILL CAROLYN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:CAROLYN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 9TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:MN
Mailing Address - Zip Code:55920-1571
Mailing Address - Country:US
Mailing Address - Phone:507-775-2629
Mailing Address - Fax:
Practice Address - Street 1:202 N BROADWAY
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-3646
Practice Address - Country:US
Practice Address - Phone:507-288-6463
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115460-9183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist