Provider Demographics
NPI:1811591076
Name:GIBSON, ZAE GARROTT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ZAE
Middle Name:GARROTT
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N BUSINESS IH 35
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-7857
Mailing Address - Country:US
Mailing Address - Phone:830-629-5096
Mailing Address - Fax:830-629-6097
Practice Address - Street 1:210 N BUSINESS IH 35
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-7857
Practice Address - Country:US
Practice Address - Phone:830-629-5096
Practice Address - Fax:830-629-6097
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62917183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist