Provider Demographics
NPI:1902998818
Name:GUILLORY, BENJAMIN ROWDY (BS)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ROWDY
Last Name:GUILLORY
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 DARDEN RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7751
Mailing Address - Country:US
Mailing Address - Phone:337-857-0682
Mailing Address - Fax:337-857-0682
Practice Address - Street 1:2210 VETERANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-4005
Practice Address - Country:US
Practice Address - Phone:337-898-2032
Practice Address - Fax:337-898-2032
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14934183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist