Provider Demographics
NPI:1801177399
Name:GUEST, EARYLL R SR (BSPHARM)
Entity type:Individual
Prefix:MR
First Name:EARYLL
Middle Name:R
Last Name:GUEST
Suffix:SR
Gender:M
Credentials:BSPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5624 HIGHWAY 78
Mailing Address - Street 2:
Mailing Address - City:SACHSE
Mailing Address - State:TX
Mailing Address - Zip Code:75048-3744
Mailing Address - Country:US
Mailing Address - Phone:469-443-0424
Mailing Address - Fax:469-443-0468
Practice Address - Street 1:5624 HIGHWAY 78
Practice Address - Street 2:
Practice Address - City:SACHSE
Practice Address - State:TX
Practice Address - Zip Code:75048-3744
Practice Address - Country:US
Practice Address - Phone:469-443-0424
Practice Address - Fax:469-443-0468
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58511183500000X
FLPS30025183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist