Provider Demographics
NPI:1013294586
Name:GILBERT, JUANITA TARVER (RPH)
Entity type:Individual
Prefix:MRS
First Name:JUANITA
Middle Name:TARVER
Last Name:GILBERT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 SAM DUNHAM RD
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-0226
Mailing Address - Country:US
Mailing Address - Phone:337-526-3158
Mailing Address - Fax:
Practice Address - Street 1:195 SAM DUNHAM RD
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-0226
Practice Address - Country:US
Practice Address - Phone:337-526-3158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist