Provider Demographics
NPI:1285380063
Name:GOBERT, ZACHARY ARTHUR
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:ARTHUR
Last Name:GOBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:COALPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16627-9269
Mailing Address - Country:US
Mailing Address - Phone:814-660-1412
Mailing Address - Fax:
Practice Address - Street 1:1120 PHILADELPHIA AVE
Practice Address - Street 2:
Practice Address - City:NORTHERN CAMBRIA
Practice Address - State:PA
Practice Address - Zip Code:15714-1359
Practice Address - Country:US
Practice Address - Phone:814-948-6102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP456559183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist