Provider Demographics
NPI:1235565581
Name:GUARDIAN PHARMACY OF TUCSON LLC
Entity Type:Organization
Organization Name:GUARDIAN PHARMACY OF TUCSON LLC
Other - Org Name:SALIBA'S EXTENDED CARE PHARMACY, TUCSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SALIBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-815-8965
Mailing Address - Street 1:GUARDIAN PHARMACY OF TUCSON DEPT 2430
Mailing Address - Street 2:P.O. BOX 11407
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-0001
Mailing Address - Country:US
Mailing Address - Phone:404-810-0089
Mailing Address - Fax:404-810-0094
Practice Address - Street 1:10900 N STALLARD PL
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-9544
Practice Address - Country:US
Practice Address - Phone:520-818-2883
Practice Address - Fax:520-818-1833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-18
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY0057203336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2142351OtherPK
AZ853339Medicaid