# GIBSON COMMUNITY HOSPITAL ASSOCIATION

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** GIBSON COMMUNITY HOSPITAL ASSOCIATION
- **Other names:** Gibson Family Pharmacy, A Member of the Medicine Shoppe Family
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1477570166
- **Legal business name:** GIBSON COMMUNITY HOSPITAL ASSOCIATION
- **Authorized official:** MR. MATTHEW ERTEL (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (217) 784-4251

## Contact information

- **Practice address:** 104 N. SANGAMON AVE, GIBSON CITY, IL 60936-1343
- **Practice address phone:** (217) 784-8545
- **Practice address fax:** (217) 784-8039
- **Mailing address:** 1120 N. MELVIN ST, GIBSON CITY, IL 60936-1477
- **Mailing address phone:** (217) 784-8545
- **Mailing address fax:** (217) 784-8039

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 054015227 | IL | Yes |

## Other

- **Enumeration date:** 07/17/2006
- **Last updated:** 07/17/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1422853 | NCPDP \# | IL |
| 05 | — | 550868762001 | — | IL |