MEDICARE: GUARDIAN PHARMACY OF OKLAHOMA CITY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1538936471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUARDIAN PHARMACY OF OKLAHOMA CITY, LLC

Provider Business Mailing Address
First Line	:	6705 CAMILLE AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73149-5202
Country	:	US
Telephone Number	:	572-213-3650
Fax Number	:	572-213-3651

Provider Business Practice Location Address
First Line	:	6705 CAMILLE AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73149-5202
Country	:	US
Telephone Number	:	572-213-3650
Fax Number	:	572-213-3651

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	TANNER CORSINI
Credential	:
Telephone Number	:	572-213-3650

Provider Enumeration Date	:	12/11/2023
Last Update Date	:	12/11/2023

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