Provider Demographics
NPI:1407163264
Name:GUILLETTE, PAUL R (RPH)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:R
Last Name:GUILLETTE
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 1:4403 LONG SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-0827
Mailing Address - Country:US
Mailing Address - Phone:505-670-2741
Mailing Address - Fax:
Practice Address - Street 1:4403 LONG SHADOW LN
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-0827
Practice Address - Country:US
Practice Address - Phone:505-670-2741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006046183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist