=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750209938
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GUARDIAN PHARMACY OF NORTHERN VIRGINIA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2026
-----------------------------------------------------
Last Update Date | 07/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1003 DOGWOOD AVE
-----------------------------------------------------
City | GROTTOES
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24441-1946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-689-0935
-----------------------------------------------------
Fax | 540-249-0441
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1003 DOGWOOD AVE
-----------------------------------------------------
City | GROTTOES
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24441-1946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-689-0935
-----------------------------------------------------
Fax | 540-249-0441
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | BRENT L ATWELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 540-689-0935
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0004X
-----------------------------------------------------
Taxonomy Name | Compounding Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------