Healthcare Provider Details

I. General information

NPI: 1437443975
Provider Name (Legal Business Name): GUARDIAN PHARMACY OF ARIZONA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 E RANCHO VISTOSO BLVD STE 131
ORO VALLEY AZ
85755-9101
US

IV. Provider business mailing address

GUARDIAN PHARMACY OF ARIZONA DEPT 2370 P.O. BOX 11407
BIRMINGHAM AL
35246-0001
US

V. Phone/Fax

Practice location:
  • Phone: 623-815-8965
  • Fax: 480-355-3006
Mailing address:
  • Phone: 404-389-1316
  • Fax: 404-389-1317

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 NumberY005379
License Number StateAZ

VIII. Authorized Official

Name: JOHN SALIBA
Title or Position: PRESIDENT
Credential:
Phone: 623-815-8965