# GUARDIAN PHARMACY OF SOUTHEAST GA LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** GUARDIAN PHARMACY OF SOUTH GEORGIA
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326078007
- **Authorized official:** JODI DINELLO (PRESIDENT)
- **Authorized official phone:** (912) 764-7839

## Contact information

- **Practice address:** 10929 HWY 301 SOUTH, STE 110 111, STATESBORO, GA 30458
- **Practice address phone:** (912) 764-7839
- **Practice address fax:** (912) 489-1519
- **Mailing address:** GUARDIAN PHARMACY OF SOUTHEAST GEORGIA DEPT 2378, P.O. BOX 11407, BIRMINGHAM, AL 35246-0001
- **Mailing address phone:** (404) 810-0089
- **Mailing address fax:** (404) 810-0094

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | PHRE008143 | GA | Yes |

## Other

- **Enumeration date:** 07/05/2006
- **Last updated:** 10/12/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2013153 | PK | — |
| 05 | — | 446858035A | — | GA |