Provider Demographics
NPI:1316557937
Name:GUARDIAN PHARMACY OF TENNESSEE THREE, LLC
Entity Type:Organization
Organization Name:GUARDIAN PHARMACY OF TENNESSEE THREE, LLC
Other - Org Name:MTPS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-588-3400
Mailing Address - Street 1:661 E LANE ST STE B
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-3437
Mailing Address - Country:US
Mailing Address - Phone:855-588-3400
Mailing Address - Fax:888-417-3667
Practice Address - Street 1:661 E LANE ST STE B
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-3437
Practice Address - Country:US
Practice Address - Phone:855-588-3400
Practice Address - Fax:888-417-3667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-07
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ063451Medicaid