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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