Provider Demographics
NPI:1538936471
Name:GUARDIAN PHARMACY OF OKLAHOMA CITY, LLC
Entity type:Organization
Organization Name:GUARDIAN PHARMACY OF OKLAHOMA CITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANNER
Authorized Official - Middle Name:
Authorized Official - Last Name:CORSINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:572-213-3650
Mailing Address - Street 1:6705 CAMILLE AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73149-5202
Mailing Address - Country:US
Mailing Address - Phone:572-213-3650
Mailing Address - Fax:572-213-3651
Practice Address - Street 1:6705 CAMILLE AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73149-5202
Practice Address - Country:US
Practice Address - Phone:572-213-3650
Practice Address - Fax:572-213-3651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy