MEDICARE: GUARDIAN ANGEL PHARMACY

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	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy	27909	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2136776	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760553788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUARDIAN ANGEL PHARMACY

Provider Business Mailing Address
First Line	:	1537 N. ZARAGOZA
Second Line	:	STE 1A
City	:	EL PASO
State	:	TX
Zip	:	79936
Country	:	US
Telephone Number	:	915-850-0713
Fax Number	:	915-850-0717

Provider Business Practice Location Address
First Line	:	1537 ZARAGOSA
Second Line	:	STE 1A
City	:	EL PASO
State	:	TX
Zip	:	79936
Country	:	US
Telephone Number	:	915-850-0713
Fax Number	:	915-850-0717

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	PASCHAL IKE
Credential	:
Telephone Number	:	915-850-0713

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	04/27/2016

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Directions to “GUARDIAN ANGEL PHARMACY ” Practice Location

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