Provider Demographics
NPI:1225688229
Name:GUARDIAN PHARMACY OF GRAND RAPIDS, LLC
Entity Type:Organization
Organization Name:GUARDIAN PHARMACY OF GRAND RAPIDS, LLC
Other - Org Name:GUARDIAN PHARMACY OF MICHIGAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STAUFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-965-7480
Mailing Address - Street 1:P. O. BOX 11407
Mailing Address - Street 2:DEPT # 8130
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-8130
Mailing Address - Country:US
Mailing Address - Phone:404-389-1383
Mailing Address - Fax:404-389-1384
Practice Address - Street 1:2930 29TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-1723
Practice Address - Country:US
Practice Address - Phone:616-965-7480
Practice Address - Fax:616-974-8205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-12
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy