1831613231 NPI number — GUARDIAN PHARMACY OF SOUTHERN CALIFORNIA LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831613231 NPI number — GUARDIAN PHARMACY OF SOUTHERN CALIFORNIA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GUARDIAN PHARMACY OF SOUTHERN CALIFORNIA 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:
Provider Other Organization Name Type Code:
6
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:
1831613231
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11407 DEPT 2672
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35246-2672
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
14048100089
Provider Business Mailing Address Fax Number:
404-810-0094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
184 E LIBERTY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANAHEIM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92801-1011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-220-0720
Provider Business Practice Location Address Fax Number:
714-525-4100
Provider Enumeration Date:
07/28/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BELVILLE
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
858-652-6900

Provider Taxonomy Codes

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

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





Copyright © 2007-2025 www.npivalidator.com