MEDICARE: GUARDIAN PHARMACY OF ARIZONA, 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	Y03869	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	Z90476	OTHER	AZ	MEDICARE MASS IMMUNIZATION

Other Identifiers

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

General Provider Information

NPI Number	:	1598755944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUARDIAN PHARMACY OF ARIZONA, LLC

Provider Business Mailing Address
First Line	:	GUARDIAN PHARMACY OF ARIZONA DEPT 2370
Second Line	:	P.O. BOX 11407
City	:	BIRMINGHAM
State	:	AL
Zip	:	35246-2370
Country	:	US
Telephone Number	:	404-810-0089
Fax Number	:	404-810-0094

Provider Business Practice Location Address
First Line	:	925 E COVEY LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85024-5674
Country	:	US
Telephone Number	:	623-815-8965
Fax Number	:	623-815-1222

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN D SALIBA
Credential	:	RPH
Telephone Number	:	623-815-8965

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	05/24/2021

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