Provider Demographics
NPI:1447565833
Name:PHILIBERT, GORDON NORBERT (RPH)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:NORBERT
Last Name:PHILIBERT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-2622
Mailing Address - Country:US
Mailing Address - Phone:985-735-6434
Mailing Address - Fax:985-735-6890
Practice Address - Street 1:217 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-2622
Practice Address - Country:US
Practice Address - Phone:985-735-6434
Practice Address - Fax:985-735-6890
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11803183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist