Provider Demographics
NPI:1083023311
Name:GILBERT, JEANINE (PHARM D)
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:
Last Name:GILBERT
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 W AIRLINE HWY
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-3331
Mailing Address - Country:US
Mailing Address - Phone:985-652-8781
Mailing Address - Fax:
Practice Address - Street 1:1616 W AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3331
Practice Address - Country:US
Practice Address - Phone:985-652-8781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16944183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist