Provider Demographics
NPI:1760553788
Name:GUARDIAN ANGEL PHARMACY
Entity Type:Organization
Organization Name:GUARDIAN ANGEL PHARMACY
Other - Org Name:GUARDIAN ANGEL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PASCHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:IKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-850-0713
Mailing Address - Street 1:1537 N. ZARAGOZA
Mailing Address - Street 2:STE 1A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936
Mailing Address - Country:US
Mailing Address - Phone:915-850-0713
Mailing Address - Fax:915-850-0717
Practice Address - Street 1:1537 ZARAGOSA
Practice Address - Street 2:STE 1A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936
Practice Address - Country:US
Practice Address - Phone:915-850-0713
Practice Address - Fax:915-850-0717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336H0001X
TX279093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Not Answered3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136776OtherPK
TX145448Medicaid
5257050001Medicare NSC