Provider Demographics
NPI:1255096244
Name:GUILLEN, TRISTAN (PHARM D)
Entity type:Individual
Prefix:
First Name:TRISTAN
Middle Name:
Last Name:GUILLEN
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 1:135 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827
Mailing Address - Country:US
Mailing Address - Phone:607-687-0891
Mailing Address - Fax:607-687-2937
Practice Address - Street 1:153 MAIN ST
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-1779
Practice Address - Country:US
Practice Address - Phone:607-687-0891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist