Provider Demographics
NPI:1134219066
Name:VIGUERIE, GEORGE M (RPH)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:M
Last Name:VIGUERIE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:VIGUERIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:1500 LAKE SIDE DR
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-1419
Mailing Address - Country:US
Mailing Address - Phone:337-367-6608
Mailing Address - Fax:
Practice Address - Street 1:1419 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:LA
Practice Address - Zip Code:70538-3722
Practice Address - Country:US
Practice Address - Phone:337-828-0950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16054183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist