Provider Demographics
NPI:1649793902
Name:GIBSON, STEPHEN (PHARMD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:GIBSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 MANCHESTER ST STE 5A
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5101
Mailing Address - Country:US
Mailing Address - Phone:603-606-9357
Mailing Address - Fax:603-217-2075
Practice Address - Street 1:117 MANCHESTER ST STE 5A
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5101
Practice Address - Country:US
Practice Address - Phone:603-606-9357
Practice Address - Fax:603-217-2075
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4196183500000X
NH41509701835P0018X, 1835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric
No183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist