Provider Demographics
NPI:1861407587
Name:GILBOW, MICHAEL GENE (RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GENE
Last Name:GILBOW
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 1:103 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DREW
Mailing Address - State:MS
Mailing Address - Zip Code:38737-3406
Mailing Address - Country:US
Mailing Address - Phone:662-745-2966
Mailing Address - Fax:662-745-8919
Practice Address - Street 1:103 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DREW
Practice Address - State:MS
Practice Address - Zip Code:38737-3406
Practice Address - Country:US
Practice Address - Phone:662-745-2966
Practice Address - Fax:662-745-8919
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS01753183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS2515180OtherNCPDP
MS0203-6329Medicaid