Active NPI
Gibson Family Pharmacy PC
Doing business as Medicine Shoppe
- Community/Retail Pharmacy
- Clovis, NM
National Provider Identifier
1821160615
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- GIBSON FAMILY PHARMACY PC
- Doing business as
- Medicine Shoppe
- Practice address
- 1801 W 21St St
Clovis, NM 88101-4023 - Phone
- (575) 762-4579
- Fax
- (575) 762-9612
- NPI assigned
- Nov 15, 2006
- Last updated
- Mar 7, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jim Herman, RPH
- Title
- Owner Pharmacist
- Phone
- (575) 762-4579
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | PH1134 | NM | |
| Community/Retail Pharmacy | 3336C0003X | NU | Primary |
Addresses
Primary practice location
1801 W 21St St
Clovis, NM 88101-4023
Mailing address
1801 W 21St St
Clovis, NM 88101-4023
Phone (575) 762-4579
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3200362 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 67454 | Medicaid | NM |
Other names 1
- MEDICINE SHOPPE
National Provider Directory
National Provider Directory- Tax ID family
- Family Institutional Pharmacy Services
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Family Institutional Pharmacy Services
- Long Term Care Pharmacy
- Clovis, NM
- NPI 1043341951
Locations
1801 W 21st St
Clovis, NM 88101
Phone (575) 763-3311
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1678147200000",
"number": "1821160615",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1801 W 21ST ST",
"city": "CLOVIS",
"state": "NM",
"postal_code": "881014023",
"telephone_number": "575-762-4579",
"fax_number": "575-762-9612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1801 W 21ST ST",
"city": "CLOVIS",
"state": "NM",
"postal_code": "881014023",
"telephone_number": "575-762-4579",
"fax_number": "575-762-9612"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GIBSON FAMILY PHARMACY PC",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-15",
"last_updated": "2023-03-07",
"status": "A",
"authorized_official_last_name": "HERMAN",
"authorized_official_first_name": "JIM",
"authorized_official_title_or_position": "OWNER PHARMACIST",
"authorized_official_telephone_number": "575-762-4579",
"authorized_official_credential": "RPH"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "NM",
"license": "PH1134",
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
"identifier": "3200362",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "67454",
"state": "NM"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "MEDICINE SHOPPE",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Clovis, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.