Healthcare Provider Details

I. General information

NPI: 1851453468
Provider Name (Legal Business Name): GUARDIAN PHARMACY OF SOUTHEAST FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 BROKEN SOUND PKWY NW STE 1
BOCA RATON FL
33487-2790
US

IV. Provider business mailing address

GUARDIAN PHARMACY OF SOUTHEAST FLORIDA DEPT 2355 P.O. BOX 11407
BIRMINGHAM AL
35246-0001
US

V. Phone/Fax

Practice location:
  • Phone: 954-601-2121
  • Fax: 954-601-2400
Mailing address:
  • Phone: 404-810-0089
  • Fax: 404-810-0094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPH22966
License Number StateFL

VIII. Authorized Official

Name: ALAN TRASTER
Title or Position: PRESIDENT
Credential:
Phone: 954-601-2121