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General NPI Number Information
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NPI Number | 1275111775
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Entity Type | Organization
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Legal Business Name | GUARDIAN PHARMACY OF MINNEAPOLIS, LLC
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Dates
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Enumeration Date | 03/29/2021
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 9700 W 76TH ST STE 116
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-4202
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Country | US
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Telephone | 952-206-4380
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Fax | 855-707-2501
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Provider Business Mailing Address
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Address Line | 9700 W 76TH ST STE 116
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-4202
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Country | US
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Telephone | 952-206-4380
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Fax | 855-707-2501
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Authorized Official
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Title or Position | PRESIDENT
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Name | CASEY CHARLES HALCROW
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Credential | PHARMD
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Telephone | 952-206-4380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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