Provider Demographics
NPI:1255965661
Name:GIBISON YU, KATHERINE M (PHARMD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:GIBISON YU
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 1:1139 N ARLINGTON HEIGHTS RD UNIT 107
Mailing Address - Street 2:
Mailing Address - City:ITASCA
Mailing Address - State:IL
Mailing Address - Zip Code:60143-3192
Mailing Address - Country:US
Mailing Address - Phone:856-981-2628
Mailing Address - Fax:
Practice Address - Street 1:445 E MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-2203
Practice Address - Country:US
Practice Address - Phone:630-893-5171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0005165183500000X
NJ28RI03933900183500000X
IL051.302809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist