Provider Demographics
NPI:1134195571
Name:GIBERSON, SCOTT F (RPH)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:F
Last Name:GIBERSON
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 1:6057 WATSON CT
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21774-6328
Mailing Address - Country:US
Mailing Address - Phone:301-865-1407
Mailing Address - Fax:301-594-6213
Practice Address - Street 1:801 THOMPSON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1627
Practice Address - Country:US
Practice Address - Phone:301-433-2449
Practice Address - Fax:301-594-6213
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-26
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP - 039745-L183500000X
NMRP - 00005624183500000X
NMPHC - 0000181835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN