Provider Demographics
NPI:1841749801
Name:MCLAUGHLIN, JEAN GABRIELLE
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:GABRIELLE
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:GABRIELLE LOUISE
Other - Last Name:MANUEL-TAYAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4780 HICKORY BLVD
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:NC
Mailing Address - Zip Code:28630-8237
Mailing Address - Country:US
Mailing Address - Phone:828-396-3685
Mailing Address - Fax:828-396-7282
Practice Address - Street 1:4780 HICKORY BLVD
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:NC
Practice Address - Zip Code:28630-8237
Practice Address - Country:US
Practice Address - Phone:828-396-3685
Practice Address - Fax:828-396-7282
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26473183500000X
VA0202215230183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist