Individual
ROGER GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1676 WESTPARK DR, BOWLING GREEN, KY 42104
(888) 555-1212
Mailing address
140 TRIPLE CROWN CT, BOWLING GREEN, KY 42104-8567
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
012567
KY
183500000X
Pharmacist
12015
TN
Other
Enumeration date
04/04/2014
Last updated
04/04/2014
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