Provider Demographics
NPI:1043707987
Name:GUARDIAN PHARMACY OF MADISON, LLC
Entity Type:Organization
Organization Name:GUARDIAN PHARMACY OF MADISON, LLC
Other - Org Name:MALLATT'S HOME CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP-PURCHASING & PAYOR RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCH
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:404-532-5011
Mailing Address - Street 1:3250 KINGSLEY WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-1383
Mailing Address - Country:US
Mailing Address - Phone:608-310-9922
Mailing Address - Fax:608-442-8490
Practice Address - Street 1:3250 KINGSLEY WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-1383
Practice Address - Country:US
Practice Address - Phone:608-310-9922
Practice Address - Fax:608-442-8490
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GUARDIAN PHARMACY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9504-423336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy