Provider Demographics
NPI:1124541289
Name:GUILBEAU, LARRY JULIEN
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:JULIEN
Last Name:GUILBEAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:CECILIA
Mailing Address - State:LA
Mailing Address - Zip Code:70521-0081
Mailing Address - Country:US
Mailing Address - Phone:337-349-1546
Mailing Address - Fax:
Practice Address - Street 1:123 FUSELIER RD
Practice Address - Street 2:
Practice Address - City:ARNAUDVILLE
Practice Address - State:LA
Practice Address - Zip Code:70512-6134
Practice Address - Country:US
Practice Address - Phone:337-754-5231
Practice Address - Fax:337-754-7976
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA009709183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA009709OtherBOARD OF PHARMACY