Organization
GUARDIAN PHARMACY OF VIRGINIA LLC
Active
Other names
Southern Pharmacy Services
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD TERRY (PRESIDENT)
(866) 768-8479
Entity
Organization
Contact information
Practice address
860 STAFFORD UMBERGER DR, WYTHEVILLE, VA 24382
(276) 228-5940
(866) 928-3983
Mailing address
GUARDIAN PHARMACY OF VIRGINIA DEPT 2428, P.O. BOX 11407, BIRMINGHAM, AL 35246-2428
(404) 810-0089
(404) 810-0094
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
11375
NC
3336L0003X
Long Term Care Pharmacy
Primary
201003165
VA
3336L0003X
Long Term Care Pharmacy
3903
TN
3336L0003X
Long Term Care Pharmacy
MO0559211
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447500400
—
VA
05
—
3810024876
—
WV
01
—
4844266
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/17/2012
Last updated
08/10/2018
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