Healthcare Provider Details

I. General information

NPI: 1285768994
Provider Name (Legal Business Name): GUARDIAN LONG TERM CARE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 OLD NEWPORT ST STE 1
NANTICOKE PA
18634-1327
US

IV. Provider business mailing address

123 BRUBAKER RD
BROCKWAY PA
15824-2505
US

V. Phone/Fax

Practice location:
  • Phone: 570-812-0300
  • Fax: 570-812-0030
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP481661
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRIAN RENDOS
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 814-503-7400