Provider Demographics
NPI:1164014072
Name:GUILLARD, DENNIS LEE
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:LEE
Last Name:GUILLARD
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 1:25347 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:MC MILLAN
Mailing Address - State:MI
Mailing Address - Zip Code:49853-9269
Mailing Address - Country:US
Mailing Address - Phone:231-383-0431
Mailing Address - Fax:
Practice Address - Street 1:7293 M 123
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:MI
Practice Address - Zip Code:49868-8127
Practice Address - Country:US
Practice Address - Phone:906-293-8571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022954183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist