=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831129519
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GUARDIAN PHARMACY OF BIRMINGHAM LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2006
-----------------------------------------------------
Last Update Date | 09/27/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1950 CRESTWOOD BLVD
-----------------------------------------------------
City | IRONDALE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35210-2034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-879-5300
-----------------------------------------------------
Fax | 205-879-5320
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | GUARDIAN PHARMACY OF BIRMINGHAM DEPT 2397 P.O. BOX 11407
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35246-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-810-0089
-----------------------------------------------------
Fax | 404-521-5056
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PHILIP BOYD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 205-879-5300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number | 111890
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------