Provider Demographics
NPI:1912114695
Name:GIBSON'S PHARMACY OF JONESBORO, INC.
Entity Type:Organization
Organization Name:GIBSON'S PHARMACY OF JONESBORO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:RON
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:870-972-9125
Mailing Address - Street 1:403 E MATTHEWS AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3142
Mailing Address - Country:US
Mailing Address - Phone:870-972-9125
Mailing Address - Fax:870-972-1624
Practice Address - Street 1:403 E MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3142
Practice Address - Country:US
Practice Address - Phone:870-972-9125
Practice Address - Fax:870-972-1624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR0412798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0706610001Medicare ID - Type Unspecified