Provider Demographics
NPI:1821367186
Name:GUBBINS, TERRY VAN (RPH)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:VAN
Last Name:GUBBINS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14426 SUNDIAL PL
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5888
Mailing Address - Country:US
Mailing Address - Phone:813-789-0372
Mailing Address - Fax:
Practice Address - Street 1:14426 SUNDIAL PL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5888
Practice Address - Country:US
Practice Address - Phone:813-789-0372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL47364183500000X
TX26384183500000X
IL051034836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist