Provider Demographics
NPI:1649490376
Name:GIBSON, JOSEPH PATRICK (RPH)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:PATRICK
Last Name:GIBSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 PANFERIO DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32561-2246
Mailing Address - Country:US
Mailing Address - Phone:850-932-1831
Mailing Address - Fax:
Practice Address - Street 1:50 S BLUE ANGEL PKWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-6045
Practice Address - Country:US
Practice Address - Phone:850-457-3293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS26203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist