Provider Demographics
NPI:1861962797
Name:GIARDINA, GERALD ANTHONY
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:ANTHONY
Last Name:GIARDINA
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 1:228 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-2704
Mailing Address - Country:US
Mailing Address - Phone:985-748-8307
Mailing Address - Fax:985-748-3089
Practice Address - Street 1:228 S 1ST ST
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-2704
Practice Address - Country:US
Practice Address - Phone:985-748-8307
Practice Address - Fax:985-748-3089
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14515183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty