Individual
ETHAN DWANE GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
118 E NEW CIRCLE RD, LEXINGTON, KY 40505-2115
(859) 254-1326
Mailing address
1738 HAYMAKER PKWY, LEXINGTON, KY 40509
(270) 590-0191
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
020779
KY
Other
Enumeration date
01/11/2018
Last updated
12/10/2020
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