Provider Demographics
NPI:1033401641
Name:GAUBERT, JONATHAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:GAUBERT
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 1:110 SAINT JOHN ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7322
Mailing Address - Country:US
Mailing Address - Phone:318-807-1083
Mailing Address - Fax:318-807-1079
Practice Address - Street 1:110 SAINT JOHN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7322
Practice Address - Country:US
Practice Address - Phone:318-807-1083
Practice Address - Fax:318-807-1079
Is Sole Proprietor?:No
Enumeration Date:2011-05-15
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017813183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist