Provider Demographics
NPI:1740788256
Name:GUITREAU, CODY (PHARMD)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:GUITREAU
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 1:15585 RED LOUPE RD
Mailing Address - Street 2:
Mailing Address - City:MAUREPAS
Mailing Address - State:LA
Mailing Address - Zip Code:70449-3536
Mailing Address - Country:US
Mailing Address - Phone:225-454-3495
Mailing Address - Fax:
Practice Address - Street 1:18525 HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:MAUREPAS
Practice Address - State:LA
Practice Address - Zip Code:70449-3015
Practice Address - Country:US
Practice Address - Phone:225-698-6000
Practice Address - Fax:225-698-6070
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022345333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy