Organization
GUARDIAN LONG TERM CARE PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN RENDOS (DIRECTOR OF OPERATIONS)
(814) 503-7400
Entity
Organization
Contact information
Practice address
147 OLD NEWPORT ST, STE 1, NANTICOKE, PA 18634-1327
(570) 812-0300
(570) 812-0030
Mailing address
123 BRUBAKER RD, BROCKWAY, PA 15824-2505
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP481661
PA
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1015064750002
—
PA
01
—
3988079
OTHER ID NUMBER
—
Enumeration date
03/15/2007
Last updated
12/21/2007
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