Provider Demographics
NPI:1245688472
Name:GIBSON, DEBORAH A (PHARMD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-9773
Mailing Address - Country:US
Mailing Address - Phone:847-854-8274
Mailing Address - Fax:847-854-5302
Practice Address - Street 1:107 S RANDALL RD
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-9773
Practice Address - Country:US
Practice Address - Phone:847-854-8274
Practice Address - Fax:847-854-5302
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.291612183500000X
MO2007032821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist