Provider Demographics
NPI:1013429455
Name:GUARDIAN PHARMACY OF IOWA, LLC
Entity Type:Organization
Organization Name:GUARDIAN PHARMACY OF IOWA, LLC
Other - Org Name:ANKENY PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROCKFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-963-1640
Mailing Address - Street 1:PO BOX 11407
Mailing Address - Street 2:DEPT #5862
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-5862
Mailing Address - Country:US
Mailing Address - Phone:404-810-0089
Mailing Address - Fax:
Practice Address - Street 1:1325 SW ORALABOR RD
Practice Address - Street 2:STE 200
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-8046
Practice Address - Country:US
Practice Address - Phone:515-289-4008
Practice Address - Fax:515-289-2383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
IA16213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0410866Medicaid
2175018OtherPK