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General NPI Number Information
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NPI Number | 1285024125
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Entity Type | Organization
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Legal Business Name | GUARDIAN PHARMACY OF SOUTHWEST FLORIDA LLC
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Dates
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Enumeration Date | 01/30/2015
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Last Update Date | 08/27/2021
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Provider Practice Location Address
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Address Line | 4873 PLANTATION BLVD.
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City | NORTH PORT
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State | FL
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Zip | 34289-9503
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Country | US
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Telephone | 941-255-1987
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Fax | 941-629-5507
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Provider Business Mailing Address
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Address Line | PO BOX 11407 DEPT #2464
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City | BIRMINGHAM
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State | AL
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Zip | 35246-2464
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Country | US
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Telephone | 404-554-1647
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Fax | 404-554-1648
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIKE KLEIN
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Credential |
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Telephone | 941-255-1987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | 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 | PH28854
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License Number State | FL
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