Provider Demographics
NPI:1295034155
Name:ROBERIE, GERVIS JOSEPH II (PD)
Entity Type:Individual
Prefix:DR
First Name:GERVIS
Middle Name:JOSEPH
Last Name:ROBERIE
Suffix:II
Gender:M
Credentials:PD
Other - Prefix:DR
Other - First Name:GERVIS
Other - Middle Name:JOSEPH
Other - Last Name:ROBERIE
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4510 AMBASSADOR CAFFERY PKW
Mailing Address - Street 2:118 GARRIGUE DR
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6887
Mailing Address - Country:US
Mailing Address - Phone:337-948-6191
Mailing Address - Fax:
Practice Address - Street 1:4510 AMBASSADOR CAFFERY PKW
Practice Address - Street 2:118 GARRIGUE DR
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6887
Practice Address - Country:US
Practice Address - Phone:337-988-7290
Practice Address - Fax:337-993-0266
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9293183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist