Organization
GIBSON FAMILY PHARMACY PC
Active
Organization
GIBSON FAMILY PHARMACY PC
Active
Other names
FAMILY INSTITUTIONAL PHARMACY SERVICES
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES HERMAN RPH (PIC AND PRESIDENT)
(505) 762-9621
Entity
Organization
Contact information
Practice address
1801 W 21ST ST STE B, CLOVIS, NM 88101-4023
(505) 762-9621
(505) 762-9612
Mailing address
1801 W 21ST ST STE B, CLOVIS, NM 88101-4023
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336I0012X
Institutional Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
PH001818
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3209346
OTHER ID NUMBER
—
05
—
661617
—
NM
Enumeration date
03/09/2007
Last updated
09/12/2007
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