Provider Demographics
NPI:1942570692
Name:JUDICE, MICHELLE GUARINO (RPH)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:GUARINO
Last Name:JUDICE
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 1:218 N HOLLINGSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-3649
Mailing Address - Country:US
Mailing Address - Phone:337-893-1612
Mailing Address - Fax:337-893-6306
Practice Address - Street 1:2640 NORTH DR
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-4043
Practice Address - Country:US
Practice Address - Phone:337-893-6304
Practice Address - Fax:337-893-6306
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15909183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist