1740485556 NPI number — GUARDIAN PHARMACY OF TAMPA, LLC

Table of content: (NPI 1740485556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740485556 NPI number — GUARDIAN PHARMACY OF TAMPA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GUARDIAN PHARMACY OF TAMPA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GUARDIAN PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740485556
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
GUARDIAN PHARMACY OF TAMPA DEPT 2340
Provider Second Line Business Mailing Address:
P.O. BOX 11407
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35246-2389
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-810-0089
Provider Business Mailing Address Fax Number:
404-521-5056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9402 INTERNATIONAL CT.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33716-4801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-577-0000
Provider Business Practice Location Address Fax Number:
727-577-5100
Provider Enumeration Date:
06/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TAYMANS
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
727-577-0000

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  PH22757 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: PH22757 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 032147800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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