Organization
GRAHAM GIBSON'T PHY., INC.
Active
Other names
Super Value Drug
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LOWRY K. MAYO RPH (PRESIDENT)
(940) 549-4600
Entity
Organization
Contact information
Practice address
1005 HIGHWAY 16 S, GRAHAM, TX 76450-3835
(940) 549-4600
(940) 549-4666
Mailing address
PO BOX 1140, GRAHAM, TX 76450-1140
(940) 549-4600
(940) 549-4666
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
TX
3336C0003X
Community/Retail Pharmacy
Primary
03797
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4521224
NCPDP (NABP) NUMBER
TX
05
—
4521224
—
TX
Enumeration date
08/31/2006
Last updated
04/17/2008
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