Active NPI
Jeremy Gibson
- Pharmacist
- Madison, MS
National Provider Identifier
1124494166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- E-13947
- Practice address
- 1606 Highland Colony Pkwy
Madison, MS 39110-6917 - Phone
- (601) 605-5928
- NPI assigned
- Aug 13, 2015
- Last updated
- Aug 13, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | E-13947 | MS | Primary |
Addresses
Primary practice location
1606 Highland Colony Pkwy
Madison, MS 39110-6917
Mailing address
150 Park Circle Dr Apt B19
Flowood, MS 39232-7631
Phone (228) 238-9478
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E-13947 | MS | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439424000000",
"number": "1124494166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150 PARK CIRCLE DR APT B19",
"city": "FLOWOOD",
"state": "MS",
"postal_code": "392327631",
"telephone_number": "228-238-9478"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1606 HIGHLAND COLONY PKWY",
"city": "MADISON",
"state": "MS",
"postal_code": "391106917",
"telephone_number": "601-605-5928"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "JEREMY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-08-13",
"last_updated": "2015-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MS",
"license": "E-13947",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.