MEDICARE: GUARDIAN PHARMACY OF EASTERN NC, 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336L0003X	Long Term Care Pharmacy	10965	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2130222	OTHER		PK

General Provider Information

NPI Number	:	1730478827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUARDIAN PHARMACY OF EASTERN NC, LLC

Provider Business Mailing Address
First Line	:	GUARDIAN PHARMACY OF EASTERN NC, LLC
Second Line	:	1029 E MOUNTAIN ST
City	:	KERNERSVILLE
State	:	NC
Zip	:	27284-7902
Country	:	US
Telephone Number	:	404-389-1383
Fax Number	:	404-389-1384

Provider Business Practice Location Address
First Line	:	1029 E MOUNTAIN ST
Second Line	:
City	:	KERNERSVILLE
State	:	NC
Zip	:	27284-7902
Country	:	US
Telephone Number	:	866-768-8479
Fax Number	:	866-928-3983

Authorized Official
Title or Position	:	CO-PRESIDENT
Name	:	CHAD TERRY
Credential	:
Telephone Number	:	866-768-8479

Provider Enumeration Date	:	03/30/2011
Last Update Date	:	07/23/2024

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