Provider Demographics
NPI:1568137362
Name:GUILLAUME, DYLAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:GUILLAUME
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 1:5139 HIGH COTTON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCISVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70775-6801
Mailing Address - Country:US
Mailing Address - Phone:225-718-5464
Mailing Address - Fax:
Practice Address - Street 1:2001 ONEAL LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3204
Practice Address - Country:US
Practice Address - Phone:225-756-8536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.023943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist