Individual
BRADLEY E GIBBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
1771 DUNLAWTON AVE, PORT ORANGE, FL 32127-4757
(386) 767-6082
Mailing address
841 CLEAR LAKE DR, PORT ORANGE, FL 32127-7780
(505) 907-2924
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
3954
NM
183500000X
Pharmacist
Primary
PS56034
FL
Other
Enumeration date
09/02/2006
Last updated
12/01/2020
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