Provider Demographics
NPI:1912557364
Name:GUIDRY, ALEXIS ANGELLE (RPH)
Entity Type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:ANGELLE
Last Name:GUIDRY
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 1:30 OAK PL
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-3087
Mailing Address - Country:US
Mailing Address - Phone:225-270-0702
Mailing Address - Fax:
Practice Address - Street 1:1800 W LAUREL AVE
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-2902
Practice Address - Country:US
Practice Address - Phone:337-546-0109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.023193183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist