Provider Demographics
NPI:1285051995
Name:GIBEAULT, JEAN PAUL (RPH, PHARMD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:PAUL
Last Name:GIBEAULT
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 ERIE ST
Mailing Address - Street 2:NEWPORT PHARMACY
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-1717
Mailing Address - Country:US
Mailing Address - Phone:201-963-1903
Mailing Address - Fax:
Practice Address - Street 1:165 ERIE ST
Practice Address - Street 2:NEWPORT PHARMACY
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-1717
Practice Address - Country:US
Practice Address - Phone:201-963-1903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-20
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03326600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist