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NPI Code Detail

MEDICARE: GUARDIAN PHARMACY OF MINNESOTA LLC

MEDICARE: GUARDIAN PHARMACY OF MINNESOTA 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
1333600000XPharmacy
23336L0003XLong Term Care Pharmacy263805MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22132903OTHERPK

General Provider Information

NPI Number : 1568732709
Entity Type Code : Organization
Provider Name (Legal Business Name) : GUARDIAN PHARMACY OF MINNESOTA LLC
Provider Business Mailing Address
First Line : DEPT # 2410 GUARDIAN PHARMACY OF MINNESOTA
Second Line : P.O. BOX 11407
City : BIRMINGHAM
State : AL
Zip : 35246-0001
Country : US
Telephone Number : 404-810-0089
Fax Number : 404-810-0094
Provider Business Practice Location Address
First Line : 940 INDUSTRIAL DR S
Second Line : SUITE 102
City : SAUK RAPIDS
State : MN
Zip : 56379-1271
Country : US
Telephone Number : 320-230-1050
Fax Number : 320-230-1051
Authorized Official
Title or Position : PRESIDENT
Name : MARK BOE
Credential :
Telephone Number : 320-257-8758
Provider Enumeration Date : 01/05/2012
Last Update Date : 09/19/2025

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