Provider Demographics
NPI:1265912679
Name:LEBEAU, JARRET (PHARMD)
Entity type:Individual
Prefix:
First Name:JARRET
Middle Name:
Last Name:LEBEAU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 SHEFFIELD ST
Mailing Address - Street 2:
Mailing Address - City:PHILIPSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16866-1847
Mailing Address - Country:US
Mailing Address - Phone:814-592-2411
Mailing Address - Fax:
Practice Address - Street 1:201 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-7969
Practice Address - Country:US
Practice Address - Phone:570-372-8803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP452517183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist