Provider Demographics
NPI:1851388508
Name:GIBSON DISCOUNT PHARMACY OF MARSHALL INC
Entity Type:Organization
Organization Name:GIBSON DISCOUNT PHARMACY OF MARSHALL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:EASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:903-935-7775
Mailing Address - Street 1:110 E END BLVD N
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-3602
Mailing Address - Country:US
Mailing Address - Phone:903-935-7775
Mailing Address - Fax:903-938-3521
Practice Address - Street 1:110 E END BLVD N
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-3602
Practice Address - Country:US
Practice Address - Phone:903-935-7775
Practice Address - Fax:903-938-3521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00352332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX108393301Medicaid
TX4510942OtherNABP
TX120675Medicaid
TX010944901Medicaid
TX4510942OtherNABP