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General NPI Number Information
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NPI Number | 1508896291
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Entity Type | Organization
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Legal Business Name | GUARDIAN PHARMACY OF JACKSONVILLE
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 08/24/2016
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Provider Practice Location Address
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Address Line | 8001 BELFORT PKWY STE 160
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City | JACKSONVILLE
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State | FL
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Zip | 32256-6966
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Country | US
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Telephone | 904-296-0016
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Fax | 904-296-0604
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Provider Business Mailing Address
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Address Line | GUARDIAN PHARMACY OF JACKSONVILLE DEPT 2346 P.O. BOX 11407
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City | BIRMINGHAM
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State | AL
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Zip | 35246-0001
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Country | US
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Telephone | 904-296-0016
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Fax | 904-296-0604
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Authorized Official
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Title or Position | PRESIDENT
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Name | KHRISTY MCCLELLAND
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Credential | RPH
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Telephone | 904-296-0016
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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 | PH21100
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License Number State | FL
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