Provider Demographics
NPI:1144240086
Name:GUARDIAN PHARMACY OF SOUTH CAROLINA ONE
Entity Type:Organization
Organization Name:GUARDIAN PHARMACY OF SOUTH CAROLINA ONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:COLVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-545-8800
Mailing Address - Street 1:810 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-3964
Mailing Address - Country:US
Mailing Address - Phone:843-545-8800
Mailing Address - Fax:843-545-8803
Practice Address - Street 1:810 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-3964
Practice Address - Country:US
Practice Address - Phone:843-545-8800
Practice Address - Fax:843-545-8803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC779713Medicaid
SC779713Medicaid
SC5905580001Medicare NSC