Provider Demographics
NPI:1740485556
Name:GUARDIAN PHARMACY OF TAMPA, LLC
Entity type:Organization
Organization Name:GUARDIAN PHARMACY OF TAMPA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYMANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-577-0000
Mailing Address - Street 1:GUARDIAN PHARMACY OF TAMPA DEPT 2340
Mailing Address - Street 2:P.O. BOX 11407
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-2389
Mailing Address - Country:US
Mailing Address - Phone:404-810-0089
Mailing Address - Fax:404-521-5056
Practice Address - Street 1:9402 INTERNATIONAL CT.
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-4801
Practice Address - Country:US
Practice Address - Phone:727-577-0000
Practice Address - Fax:727-577-5100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH22757332B00000X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL032147800Medicaid
FL032147800Medicaid