1598755944 NPI number — GUARDIAN PHARMACY OF ARIZONA, LLC

Table of content: (NPI 1598755944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598755944 NPI number — GUARDIAN PHARMACY OF ARIZONA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GUARDIAN PHARMACY OF ARIZONA, 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:
SALIBAS EXTENDED CARE 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:
1598755944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
GUARDIAN PHARMACY OF ARIZONA DEPT 2370
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:
35246-2370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-810-0089
Provider Business Mailing Address Fax Number:
404-810-0094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
925 E COVEY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85024-5674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-815-8965
Provider Business Practice Location Address Fax Number:
623-815-1222
Provider Enumeration Date:
10/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SALIBA
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
623-815-8965

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  Y03869 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 478934 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: Z90476 . This is a "MEDICARE MASS IMMUNIZATION" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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