Provider Demographics
NPI:1891077897
Name:STELLY, MYLES REGAN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MYLES
Middle Name:REGAN
Last Name:STELLY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WESTGATE RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-2710
Mailing Address - Country:US
Mailing Address - Phone:337-232-5506
Mailing Address - Fax:337-234-4236
Practice Address - Street 1:111 WESTGATE RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-2710
Practice Address - Country:US
Practice Address - Phone:337-232-5506
Practice Address - Fax:337-234-4236
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist