Provider Demographics
NPI:1447797477
Name:GUIDRY, STACI (RPH)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:
Last Name:GUIDRY
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 1:1401 WAVERLY ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-6139
Mailing Address - Country:US
Mailing Address - Phone:337-526-2077
Mailing Address - Fax:
Practice Address - Street 1:366 SAM HOUSTON JONES PKWY
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70611-5602
Practice Address - Country:US
Practice Address - Phone:337-855-1341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-29
Last Update Date:2017-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.021891183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist