Provider Demographics
NPI:1760774277
Name:GLYNN, ANGELA GUARISCO (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:GUARISCO
Last Name:GLYNN
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 1:2252 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-3705
Mailing Address - Country:US
Mailing Address - Phone:337-988-7280
Mailing Address - Fax:337-406-2547
Practice Address - Street 1:2252 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-3705
Practice Address - Country:US
Practice Address - Phone:337-988-7280
Practice Address - Fax:337-406-2547
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10638183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist