Provider Demographics
NPI:1144876210
Name:GAIBORT, JEAN ANDRES (PHARMD)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:ANDRES
Last Name:GAIBORT
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 1:247 REX PL APT E
Mailing Address - Street 2:
Mailing Address - City:MADEIRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33708-1934
Mailing Address - Country:US
Mailing Address - Phone:407-748-5915
Mailing Address - Fax:
Practice Address - Street 1:12643 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-1221
Practice Address - Country:US
Practice Address - Phone:813-515-7918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59717183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist