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General NPI Number Information
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NPI Number | 1285125021
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Entity Type | Organization
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Legal Business Name | GUARDIAN PHARMACY LLC
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Dates
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Enumeration Date | 05/29/2018
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Last Update Date | 05/29/2018
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Provider Practice Location Address
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Address Line | 29866 FORD RD.
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City | GARDEN CITY
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State | MI
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Zip | 48135
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Country | US
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Telephone | 734-466-5001
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Fax | 734-466-5004
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Provider Business Mailing Address
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Address Line | 29866 FORD RD.
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City | GARDEN CITY
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State | MI
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Zip | 48135
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Country | US
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Telephone | 734-466-5001
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Fax | 734-466-5004
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMAD ALI ABOU-KHODR
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Credential |
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Telephone | 734-466-4001
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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 | 5301010779
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License Number State | MI
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