Individual
MR. LEVON GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
55 W AMES CT, SUITE 200, PLAINVIEW, NY 11803-2304
(516) 938-8080
Mailing address
2300 PEACHFORD RD, STE 1408, DUNWOODY, GA 30338-5846
(404) 431-3871
Taxonomy
Speciality
Code
Description
License number
State
1835G0303X
Geriatric Pharmacist
Primary
054170
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054170
PHARMACIST LICENSE NUMBER
NY
Enumeration date
07/07/2010
Last updated
07/07/2010
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