Provider Demographics
NPI:1790432847
Name:GAUTHREAUX, ROBERT DEAN JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DEAN
Last Name:GAUTHREAUX
Suffix:JR
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 1:15569 E HOFFMAN RD LOT 51
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-9407
Mailing Address - Country:US
Mailing Address - Phone:985-402-6900
Mailing Address - Fax:
Practice Address - Street 1:70550 HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8100
Practice Address - Country:US
Practice Address - Phone:985-893-7681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.024230183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist