Provider Demographics
NPI:1285039800
Name:GUARDIAN PHARMACY LLC
Entity Type:Organization
Organization Name:GUARDIAN PHARMACY LLC
Other - Org Name:GUARDIAN PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-259-4748
Mailing Address - Street 1:3980 SHERIDAN DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1727
Mailing Address - Country:US
Mailing Address - Phone:716-768-5615
Mailing Address - Fax:716-248-2163
Practice Address - Street 1:3980 SHERIDAN DR STE 304
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1727
Practice Address - Country:US
Practice Address - Phone:716-768-5615
Practice Address - Fax:716-248-2163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0330293336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2148490OtherPK
033029OtherPHARMACY