Provider Demographics
NPI:1255440806
Name:GIBBS, ERIC (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:GIBBS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:FALLS
Other - Middle Name:ROAD
Other - Last Name:PHARMACY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMACY
Mailing Address - Street 1:40 MOONBOW PLZ
Mailing Address - Street 2:SUITE #1
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-8982
Mailing Address - Country:US
Mailing Address - Phone:606-258-0000
Mailing Address - Fax:606-258-0002
Practice Address - Street 1:40 MOONBOW PLZ
Practice Address - Street 2:SUITE #1
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8982
Practice Address - Country:US
Practice Address - Phone:606-258-0000
Practice Address - Fax:606-258-0002
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY54004437 MED183500000X
KY90006305 DME183500000X
KYP06831 PHARMACY183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1827700OtherNABP
KY54004437Medicaid
KY90006305Medicaid
KY54004437Medicaid