Provider Demographics
NPI:1669682993
Name:GUIDRY, WARREN JOHN (PD)
Entity Type:Individual
Prefix:MR
First Name:WARREN
Middle Name:JOHN
Last Name:GUIDRY
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3905
Mailing Address - Country:US
Mailing Address - Phone:337-984-6935
Mailing Address - Fax:
Practice Address - Street 1:620 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-7206
Practice Address - Country:US
Practice Address - Phone:337-234-1428
Practice Address - Fax:337-234-1429
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist