Provider Demographics
NPI:1376359919
Name:GIBSON, MARLIESE ANNE (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:MARLIESE
Middle Name:ANNE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MCCONNELL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3463
Mailing Address - Country:US
Mailing Address - Phone:614-533-6219
Mailing Address - Fax:
Practice Address - Street 1:800 MCCONNELL DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3463
Practice Address - Country:US
Practice Address - Phone:614-533-6219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03230111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist