Individual
MARY LUCIA GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
795 W OVERLAND RD, MERIDIAN, ID 83642-6556
(208) 917-6902
Mailing address
4509 S CRUZATTE LN, BOISE, ID 83716-5611
(208) 854-9401
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P6455
ID
Other
Enumeration date
02/24/2021
Last updated
02/24/2021
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