Provider Demographics
NPI:1730586645
Name:GIBSON, JASON (PHARMD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:GIBSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 GLIMCHER DR
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-9415
Mailing Address - Country:US
Mailing Address - Phone:814-695-4609
Mailing Address - Fax:
Practice Address - Street 1:221 GLIMCHER DR
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-9415
Practice Address - Country:US
Practice Address - Phone:814-695-4609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP448593183500000X
PARPI008466183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist