# GUARDIAN PHARMACY OF GRAND ISLAND, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Midwest LTC Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386363877
- **Authorized official:** CODY LOBEDA (PRESIDENT/OWNER)
- **Authorized official phone:** (308) 398-0538

## Contact information

- **Practice address:** 2208 N WEBB RD UNIT 3, GRAND ISLAND, NE 68803-1756
- **Practice address phone:** (308) 398-0538
- **Practice address fax:** (308) 398-0539
- **Mailing address:** 2208 N WEBB RD UNIT 3, GRAND ISLAND, NE 68803-1756
- **Mailing address phone:** (308) 398-0538
- **Mailing address fax:** (308) 398-0539

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 08/26/2022
- **Last updated:** 08/26/2022