Provider Demographics
NPI:1982085767
Name:GUARDIAN PHARMACY OF SC ONE LLC
Entity Type:Organization
Organization Name:GUARDIAN PHARMACY OF SC ONE LLC
Other - Org Name:PREFERRED CARE PHARMACEUTICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-545-8800
Mailing Address - Street 1:PO BOX 11407
Mailing Address - Street 2:DEPT # 2487
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-2430
Mailing Address - Country:US
Mailing Address - Phone:404-810-0089
Mailing Address - Fax:404-810-0094
Practice Address - Street 1:4794A HIGHWAY 162
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:SC
Practice Address - Zip Code:29449-5740
Practice Address - Country:US
Practice Address - Phone:843-769-6522
Practice Address - Fax:843-769-5728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
SC160423336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC716042Medicaid
2152908OtherPK
ME1982085767Medicaid