Provider Demographics
NPI:1609489673
Name:JABBIA, MARY-KATHERINE LENNETTE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARY-KATHERINE
Middle Name:LENNETTE
Last Name:JABBIA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-5426
Mailing Address - Country:US
Mailing Address - Phone:985-492-5304
Mailing Address - Fax:985-492-5307
Practice Address - Street 1:224 W MAIN ST
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-5426
Practice Address - Country:US
Practice Address - Phone:985-492-5304
Practice Address - Fax:985-492-5307
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.023526183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist