Healthcare Provider Details

I. General information

NPI: 1831613231
Provider Name (Legal Business Name): GUARDIAN PHARMACY OF SOUTHERN CALIFORNIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 07/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 E LIBERTY AVE
ANAHEIM CA
92801-1011
US

IV. Provider business mailing address

PO BOX 11407 DEPT 2672
BIRMINGHAM AL
35246-2672
US

V. Phone/Fax

Practice location:
  • Phone: 714-220-0720
  • Fax: 714-525-4100
Mailing address:
  • Phone: 14048100089
  • Fax: 404-810-0094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number StateCA

VIII. Authorized Official

Name: RONALD BELVILLE
Title or Position: PRESIDENT
Credential:
Phone: 858-652-6900