Provider Demographics
NPI:1407469844
Name:GUILLORY, ROBERT JORDAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JORDAN
Last Name:GUILLORY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 W SAINT GEORGE BLVD
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3353
Mailing Address - Country:US
Mailing Address - Phone:435-652-3868
Mailing Address - Fax:435-652-9979
Practice Address - Street 1:391 W SAINT GEORGE BLVD
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3353
Practice Address - Country:US
Practice Address - Phone:435-652-3868
Practice Address - Fax:435-652-9979
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6868598-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist