Healthcare Provider Details

I. General information

NPI: 1184013799
Provider Name (Legal Business Name): GUARDIAN PHARMACY OF BIRMINGHAM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 12/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 7TH AVE
JASPER AL
35501-4377
US

IV. Provider business mailing address

PO BOX 11407 DEPT #2397
BIRMINGHAM AL
35246-2397
US

V. Phone/Fax

Practice location:
  • Phone: 205-397-4660
  • Fax: 205-397-4661
Mailing address:
  • Phone: 404-554-1647
  • Fax: 404-554-1648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number114449
License Number StateAL

VIII. Authorized Official

Name: PHILIP BOYD
Title or Position: PRESIDENT
Credential:
Phone: 205-879-5300