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General NPI Number Information
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NPI Number | 1285768994
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Entity Type | Organization
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Legal Business Name | GUARDIAN LONG TERM CARE PHARMACY INC
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 12/21/2007
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Provider Practice Location Address
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Address Line | 147 OLD NEWPORT ST STE 1
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City | NANTICOKE
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State | PA
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Zip | 18634-1327
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Country | US
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Telephone | 570-812-0300
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Fax | 570-812-0030
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Provider Business Mailing Address
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Address Line | 123 BRUBAKER RD
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City | BROCKWAY
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State | PA
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Zip | 15824-2505
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | BRIAN RENDOS
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Credential |
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Telephone | 814-503-7400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP481661
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License Number State | PA
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