Provider Demographics
NPI:1669621876
Name:GIBBS, ERIC DUANE (PHARMD, BCPS, CPP)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DUANE
Last Name:GIBBS
Suffix:
Gender:M
Credentials:PHARMD, BCPS, CPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21239 STATE HIGHWAY 14
Mailing Address - Street 2:
Mailing Address - City:MACEDONIA
Mailing Address - State:IL
Mailing Address - Zip Code:62860-1164
Mailing Address - Country:US
Mailing Address - Phone:618-439-4764
Mailing Address - Fax:
Practice Address - Street 1:1100 TUNNEL RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-2576
Practice Address - Country:US
Practice Address - Phone:828-298-7911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-039307183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051-039307OtherSTATE PHARMACY LICENSCE