Provider Demographics
NPI:1912006818
Name:APOTHECARY ALLEY LLC
Entity Type:Organization
Organization Name:APOTHECARY ALLEY LLC
Other - Org Name:GUIDRY'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST /OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUIDRY
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:337-582-3131
Mailing Address - Street 1:PO BOX 760
Mailing Address - Street 2:
Mailing Address - City:IOWA
Mailing Address - State:LA
Mailing Address - Zip Code:70647-0760
Mailing Address - Country:US
Mailing Address - Phone:337-582-3131
Mailing Address - Fax:337-582-3459
Practice Address - Street 1:204 S THOMSON AVE
Practice Address - Street 2:
Practice Address - City:IOWA
Practice Address - State:LA
Practice Address - Zip Code:70647
Practice Address - Country:US
Practice Address - Phone:337-582-3131
Practice Address - Fax:337-582-3439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LAPHY003536IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2028744OtherPK
LA1266256Medicaid
2028744OtherPK