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
- 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 and National Provider Directory roles.
-
- Pharmacy
- Madison, MS
- NPI 1477993236
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- Pharmacy
- Longview, TX
- NPI 1629956545
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.