Provider Demographics
NPI:1346612819
Name:GUILLORY, JENNIFER (RPH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GUILLORY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6216 HWY 10
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:LA
Mailing Address - Zip Code:70441
Mailing Address - Country:US
Mailing Address - Phone:225-222-6125
Mailing Address - Fax:225-222-6197
Practice Address - Street 1:6216 HWY 10
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:LA
Practice Address - Zip Code:70441
Practice Address - Country:US
Practice Address - Phone:225-222-6125
Practice Address - Fax:225-222-6197
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1936472Medicaid