Provider Demographics
NPI:1801925300
Name:GIBSON, JENNA A (PHARM D)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:A
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 SERENDIPITY LN
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:64683-8358
Mailing Address - Country:US
Mailing Address - Phone:660-359-2409
Mailing Address - Fax:
Practice Address - Street 1:601 LOCUST ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-2250
Practice Address - Country:US
Practice Address - Phone:660-646-7455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006038099183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist