Provider Demographics
NPI:1578038022
Name:GUARDIAN PHARMACY OF MADISON, LLC
Entity Type:Organization
Organization Name:GUARDIAN PHARMACY OF MADISON, LLC
Other - Org Name:GUARDIAN PHARMACY OF WISCONSIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MIKE
Authorized Official - Last Name:FLINT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-727-5750
Mailing Address - Street 1:11420 W THEODORE TRECKER WAY
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-1137
Mailing Address - Country:US
Mailing Address - Phone:414-727-5750
Mailing Address - Fax:
Practice Address - Street 1:11420 W THEODORE TRECKER WAY
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-1137
Practice Address - Country:US
Practice Address - Phone:414-727-5750
Practice Address - Fax:414-727-5770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy