Provider Demographics
NPI:1356656755
Name:GUILLORY, BEN J (RPH)
Entity Type:Individual
Prefix:MR
First Name:BEN
Middle Name:J
Last Name:GUILLORY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3317
Mailing Address - Country:US
Mailing Address - Phone:985-674-2551
Mailing Address - Fax:985-674-5334
Practice Address - Street 1:4330 HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3317
Practice Address - Country:US
Practice Address - Phone:985-674-2551
Practice Address - Fax:985-674-5334
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15285183500000X
FLPS31065183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist