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General NPI Number Information
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NPI Number | 1538936471
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Entity Type | Organization
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Legal Business Name | GUARDIAN PHARMACY OF OKLAHOMA CITY, LLC
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Dates
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Enumeration Date | 12/11/2023
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 6705 CAMILLE AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73149-5202
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Country | US
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Telephone | 572-213-3650
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Fax | 572-213-3651
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Provider Business Mailing Address
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Address Line | 6705 CAMILLE AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73149-5202
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Country | US
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Telephone | 572-213-3650
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Fax | 572-213-3651
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | TANNER CORSINI
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Credential |
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Telephone | 572-213-3650
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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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