Healthcare Provider Details

I. General information

NPI: 1710963020
Provider Name (Legal Business Name): JEANNETTE GABBERT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USAMEDDAC WUERZBURG ATTEN: CREDENTIALS UNIT 26610
APO AE
09244
DE

IV. Provider business mailing address

USAMEDDAC WUERZBURG ATTN; CREDENTIALS UNIT 26610
APO AE
09244
DE

V. Phone/Fax

Practice location:
  • Phone: 01149964183
  • Fax:
Mailing address:
  • Phone: 01149964183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number03314521
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: