Healthcare Provider Details

I. General information

NPI: 1750209938
Provider Name (Legal Business Name): GUARDIAN PHARMACY OF NORTHERN VIRGINIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 DOGWOOD AVE
GROTTOES VA
24441-1946
US

IV. Provider business mailing address

1003 DOGWOOD AVE
GROTTOES VA
24441-1946
US

V. Phone/Fax

Practice location:
  • Phone: 540-689-0935
  • Fax: 540-249-0441
Mailing address:
  • Phone: 540-689-0935
  • Fax: 540-249-0441

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 Number
License Number State

VIII. Authorized Official

Name: BRENT L ATWELL
Title or Position: PRESIDENT
Credential:
Phone: 540-689-0935