Provider Demographics
NPI:1063549855
Name:GOBBELL, JANE ANN
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:ANN
Last Name:GOBBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 CARL LN
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-4903
Mailing Address - Country:US
Mailing Address - Phone:731-926-3119
Mailing Address - Fax:
Practice Address - Street 1:555 PICKWICK ST S
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-3082
Practice Address - Country:US
Practice Address - Phone:731-925-1152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7971183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist