MEDICARE: GUARDIAN PHARMACY OF ORLANDO, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy	PH	FL

General Provider Information

NPI Number	:	1285166363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUARDIAN PHARMACY OF ORLANDO, LLC

Provider Business Mailing Address
First Line	:	PO BOX 11407
Second Line	:	DEPT #5599
City	:	BIRMINGHAM
State	:	AL
Zip	:	35246-5599
Country	:	US
Telephone Number	:	404-810-0089
Fax Number	:	404-810-0094

Provider Business Practice Location Address
First Line	:	2815 DIRECTORS ROW
Second Line	:	SUITE 700
City	:	ORLANDO
State	:	FL
Zip	:	32809-5526
Country	:	US
Telephone Number	:	404-270-6722
Fax Number	:	407-270-6723

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALAN OBRINGER
Credential	:
Telephone Number	:	407-270-6722

Provider Enumeration Date	:	03/29/2017
Last Update Date	:	03/31/2017

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