Provider Demographics
NPI: | 1548733769 |
---|---|
Name: | GUARDIAN PHARMACY OF ST. LOUIS, LLC |
Entity Type: | Organization |
Organization Name: | GUARDIAN PHARMACY OF ST. LOUIS, LLC |
Other - Org Name: | GUARDIAN PHARMACY OF ST. LOUIS, LLC |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | VP, GC & SENIOR COMPLIANCE OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DOUG |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | TOWNS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 404-727-5750 |
Mailing Address - Street 1: | P O BOX 11407 DEPT # 8072 |
Mailing Address - Street 2: | |
Mailing Address - City: | BIRMINGHAM |
Mailing Address - State: | AL |
Mailing Address - Zip Code: | 35246-8072 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 404-389-1300 |
Mailing Address - Fax: | 866-328-3491 |
Practice Address - Street 1: | 926 S HIGHWAY DR |
Practice Address - Street 2: | |
Practice Address - City: | FENTON |
Practice Address - State: | MO |
Practice Address - Zip Code: | 63026-2023 |
Practice Address - Country: | US |
Practice Address - Phone: | 866-860-4179 |
Practice Address - Fax: | 866-328-3491 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-01-10 |
Last Update Date: | 2019-03-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3336L0003X | Suppliers | Pharmacy | Long Term Care Pharmacy |