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?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy