# GUARDIAN PHARMACY OF VIRGINIA LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southern Pharmacy Services
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447500400
- **Authorized official:** CHAD TERRY (PRESIDENT)
- **Authorized official phone:** (866) 768-8479

## Contact information

- **Practice address:** 860 STAFFORD UMBERGER DR, WYTHEVILLE, VA 24382
- **Practice address phone:** (276) 228-5940
- **Practice address fax:** (866) 928-3983
- **Mailing address:** GUARDIAN PHARMACY OF VIRGINIA DEPT 2428, P.O. BOX 11407, BIRMINGHAM, AL 35246-2428
- **Mailing address phone:** (404) 810-0089
- **Mailing address fax:** (404) 810-0094

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | 11375 | NC | — |
| 3336L0003X | Long Term Care Pharmacy | 201003165 | VA | Yes |
| 3336L0003X | Long Term Care Pharmacy | 3903 | TN | — |
| 3336L0003X | Long Term Care Pharmacy | MO0559211 | WV | — |

## Other

- **Enumeration date:** 09/17/2012
- **Last updated:** 08/10/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1447500400 | — | VA |
| 05 | — | 3810024876 | — | WV |
| 01 | — | 4844266 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |