Organization
GUARDIAN PHARMACY OF TN ONE
Active
Other names
Middle Tennessee Pharmacy Services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSS SPIVEY D.P.H (PHARMACIST IN CHARGE)
(931) 684-9987
Entity
Organization
Contact information
Practice address
661 E LANE ST, SHELBYVILLE, TN 37160-3437
(931) 684-9987
(931) 684-9995
Mailing address
GUARDIAN PHARMACY OF TENNESSEE ONE DEPT 2389, P.O. BOX 11407, BIRMINGHAM, AL 35246-2389
(404) 810-0089
(404) 810-0094
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
0000004147
TN
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
0000004147
TN
3336C0004X
Compounding Pharmacy
0000004147
TN
3336H0001X
Home Infusion Therapy Pharmacy
0000004147
TN
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103G876440
LOCAL MEDICARE PART B
TN
05
—
1520567
—
TN
01
—
4276630
BCBS HIT
TN
Enumeration date
10/02/2009
Last updated
01/27/2016
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