Provider Demographics
NPI:1518393149
Name:WILLIFORD, DEVONTE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEVONTE
Middle Name:
Last Name:WILLIFORD
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 1:2845 COUNTRY CLUB RD
Mailing Address - Street 2:APT 1210
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5996
Mailing Address - Country:US
Mailing Address - Phone:404-357-8588
Mailing Address - Fax:
Practice Address - Street 1:2000 HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8060
Practice Address - Country:US
Practice Address - Phone:337-439-7114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-14
Last Update Date:2013-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist