Provider Demographics
NPI:1750383501
Name:GUILBAUD, JEAN-MAURICE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JEAN-MAURICE
Middle Name:
Last Name:GUILBAUD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:MAURICE
Other - Middle Name:
Other - Last Name:GUILBAUD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:1003 COLONNADE WAY
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-8248
Mailing Address - Country:US
Mailing Address - Phone:404-936-1677
Mailing Address - Fax:
Practice Address - Street 1:1003 COLONNADE WAY
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:GA
Practice Address - Zip Code:30004-8248
Practice Address - Country:US
Practice Address - Phone:404-936-1677
Practice Address - Fax:404-851-8610
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH019676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist