Organization
GUARDIAN PHARMACY OF SOUTHEAST GA LLC
Active
Other names
GUARDIAN PHARMACY OF SOUTH GEORGIA
Organization subpart
No
Provider details
NPI number
Authorized official
JODI DINELLO (PRESIDENT)
(912) 764-7839
Entity
Organization
Contact information
Practice address
10929 HWY 301 SOUTH, STE 110 111, STATESBORO, GA 30458
(912) 764-7839
(912) 489-1519
Mailing address
GUARDIAN PHARMACY OF SOUTHEAST GEORGIA DEPT 2378, P.O. BOX 11407, BIRMINGHAM, AL 35246-0001
(404) 810-0089
(404) 810-0094
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
PHRE008143
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2013153
PK
—
05
—
446858035A
—
GA
Enumeration date
07/05/2006
Last updated
10/12/2016
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