Provider Demographics
NPI:1285024125
Name:GUARDIAN PHARMACY OF SOUTHWEST FLORIDA LLC
Entity Type:Organization
Organization Name:GUARDIAN PHARMACY OF SOUTHWEST FLORIDA LLC
Other - Org Name:PATIENT CARE PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-255-1987
Mailing Address - Street 1:PO BOX 11407
Mailing Address - Street 2:DEPT #2464
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-2464
Mailing Address - Country:US
Mailing Address - Phone:404-554-1647
Mailing Address - Fax:404-554-1648
Practice Address - Street 1:4873 PLANTATION BLVD.
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34289-9503
Practice Address - Country:US
Practice Address - Phone:941-255-1987
Practice Address - Fax:941-629-5507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH288543336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014310700Medicaid
2150227OtherPK
2150227OtherPK