Provider Demographics
NPI:1619284965
Name:GUILLORY, LANA ALINE (RPH)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:ALINE
Last Name:GUILLORY
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 1:215 W WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-2841
Mailing Address - Country:US
Mailing Address - Phone:337-572-9053
Mailing Address - Fax:337-572-9054
Practice Address - Street 1:215 W WILLOW ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-2841
Practice Address - Country:US
Practice Address - Phone:337-572-9053
Practice Address - Fax:337-572-9054
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1896829Medicaid
LA1896829Medicaid