Provider Demographics
NPI:1518576396
Name:GUILLORY, JONMARIE IVY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JONMARIE
Middle Name:IVY
Last Name:GUILLORY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 FLORIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:LA
Mailing Address - Zip Code:70785-7914
Mailing Address - Country:US
Mailing Address - Phone:225-664-5181
Mailing Address - Fax:
Practice Address - Street 1:10200 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:LA
Practice Address - Zip Code:70785-7914
Practice Address - Country:US
Practice Address - Phone:225-664-5181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST023484183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist