Provider Demographics
NPI:1447736574
Name:GIBSON, CAMERON BRYANT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:BRYANT
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 1:7203 SMITH CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-0091
Mailing Address - Country:US
Mailing Address - Phone:252-205-1840
Mailing Address - Fax:
Practice Address - Street 1:1009 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HAW RIVER
Practice Address - State:NC
Practice Address - Zip Code:27258-9562
Practice Address - Country:US
Practice Address - Phone:336-578-4625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist