Provider Demographics
NPI:1225206907
Name:GAGNON, JEAN PAUL (RPH, PHD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:PAUL
Last Name:GAGNON
Suffix:
Gender:M
Credentials:RPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1265
Mailing Address - Country:US
Mailing Address - Phone:908-981-6953
Mailing Address - Fax:908-981-7838
Practice Address - Street 1:55 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-1265
Practice Address - Country:US
Practice Address - Phone:908-981-6953
Practice Address - Fax:908-981-7838
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07988183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist