Provider Demographics
NPI:1184013799
Name:GUARDIAN PHARMACY OF BIRMINGHAM LLC
Entity Type:Organization
Organization Name:GUARDIAN PHARMACY OF BIRMINGHAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-879-5300
Mailing Address - Street 1:PO BOX 11407
Mailing Address - Street 2:DEPT #2397
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-2397
Mailing Address - Country:US
Mailing Address - Phone:404-554-1647
Mailing Address - Fax:404-554-1648
Practice Address - Street 1:1100 7TH AVE
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-4377
Practice Address - Country:US
Practice Address - Phone:205-397-4660
Practice Address - Fax:205-397-4661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1144493336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149782OtherPK
AL168682Medicaid