Provider Demographics
NPI:1528299252
Name:GUARDIAN PHARMACY OF THE PIEDMONT CAROLINAS
Entity type:Organization
Organization Name:GUARDIAN PHARMACY OF THE PIEDMONT CAROLINAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-545-8800
Mailing Address - Street 1:GUARDIAN PHARMACY OF PIEDMONT DEPT 2382
Mailing Address - Street 2:P.O. BOX 11407
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-2382
Mailing Address - Country:US
Mailing Address - Phone:404-810-0089
Mailing Address - Fax:404-810-0094
Practice Address - Street 1:2915 WHITEHALL PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-3580
Practice Address - Country:US
Practice Address - Phone:845-545-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ523330001OtherMEDICARE FOR MASS IMMUNIZATION
NC6403160001Medicare NSC