Healthcare Provider Details

I. General information

NPI: 1235291618
Provider Name (Legal Business Name): LIFEGUARD INTEGRATIVE PHARMACIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9070 WINDSOR RD
WINDSOR CA
95492-9701
US

IV. Provider business mailing address

9070 WINDSOR RD
WINDSOR CA
95492-9701
US

V. Phone/Fax

Practice location:
  • Phone: 707-837-7948
  • Fax: 707-837-7949
Mailing address:
  • Phone: 707-837-7948
  • Fax: 707-837-7949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHY46739
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY46739
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5613561
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerNCPDP
# 2
IdentifierPHY46739
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerPHARMACY LICENSE

VIII. Authorized Official

Name: DR. MARK THOMAS BURGER
Title or Position: PRESIDENT AND CEO
Credential: PHARM.D.
Phone: 707-837-7948