Provider Demographics
NPI:1538860697
Name:GUARDIAN PHARMACY OF NORTHERN VIRGINIA, LLC
Entity type:Organization
Organization Name:GUARDIAN PHARMACY OF NORTHERN VIRGINIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-768-8479
Mailing Address - Street 1:13525 WELLINGTON CENTER CIR STE 109
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-4062
Mailing Address - Country:US
Mailing Address - Phone:866-768-8479
Mailing Address - Fax:866-928-3983
Practice Address - Street 1:13525 WELLINGTON CENTER CIR STE 109
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-4062
Practice Address - Country:US
Practice Address - Phone:866-768-8479
Practice Address - Fax:866-928-3983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy