Provider Demographics
NPI:1245509314
Name:GIBBS, WAYNE ELLIOTT
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:ELLIOTT
Last Name:GIBBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13502 S APOPKA VINELAND RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-6321
Mailing Address - Country:US
Mailing Address - Phone:407-827-1000
Mailing Address - Fax:
Practice Address - Street 1:13502 S APOPKA VINELAND RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32821-6321
Practice Address - Country:US
Practice Address - Phone:407-827-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS26202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist