Provider Demographics
NPI:1851686497
Name:GIBSON, PHILLIP TODD (RPH)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:TODD
Last Name:GIBSON
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 1:7235 BELL CREEK RD
Mailing Address - Street 2:T-1968
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-3541
Mailing Address - Country:US
Mailing Address - Phone:804-559-8831
Mailing Address - Fax:804-559-8831
Practice Address - Street 1:7235 BELL CREEK RD
Practice Address - Street 2:T-1968
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-3541
Practice Address - Country:US
Practice Address - Phone:804-559-8831
Practice Address - Fax:804-559-8831
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202204509183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist