Provider Demographics
NPI:1437443975
Name:GUARDIAN PHARMACY OF ARIZONA, LLC
Entity Type:Organization
Organization Name:GUARDIAN PHARMACY OF ARIZONA, LLC
Other - Org Name:SALIBA'S EXTENDED CARE PHARMACY
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 ARIZONA DEPT 2370
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:404-389-1316
Mailing Address - Fax:404-389-1317
Practice Address - Street 1:1171 E RANCHO VISTOSO BLVD STE 131
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-9101
Practice Address - Country:US
Practice Address - Phone:623-815-8965
Practice Address - Fax:480-355-3006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-01
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AZY0053793336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2131021OtherPK
AZ625239Medicaid