Healthcare Provider Details

I. General information

NPI: 1861798613
Provider Name (Legal Business Name): GUARDIAN PHARMACY OF NW FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 N WILSON ST
CRESTVIEW FL
32536-3438
US

IV. Provider business mailing address

GUARDIAN PHARMACY OF NW FLORIDA DEPT 2401 P.O. BOX 11407
BIRMINGHAM AL
35246-0001
US

V. Phone/Fax

Practice location:
  • Phone: 850-306-3003
  • Fax: 850-306-3004
Mailing address:
  • Phone: 404-389-1316
  • Fax:

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 NumberPH25396
License Number StateFL

VIII. Authorized Official

Name: ROBERT DUNN
Title or Position: PRESIDENT
Credential:
Phone: 850-306-3003