Organization
GUARDIAN PHARMACY OF MAINE, LLC
Active
Other names
WALTZ LONG TERM CARE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
COURTNEY OLAND (PRESIDENT)
(207) 373-9077
Entity
Organization
Contact information
Practice address
3 BUSINESS PKWY, SUITE 2, BRUNSWICK, ME 04011-7390
(207) 373-9077
(207) 373-9088
Mailing address
GUARDIAN PHARMACY OF MAINE DEPT 2374, P.O. BOX 11407, BIRMINGHAM, AL 35246-2374
(404) 810-0089
(404) 810-0094
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336L0003X
Long Term Care Pharmacy
Primary
CSP50001564
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1871672469
—
ME
01
—
2007537
NABP#
ME
05
—
3099413
—
NH
01
—
CSP50001564
PHARMACY LICENSE
ME
01
—
E100200569
MEDICARE- MASS IMMUNIZATION
ME
Enumeration date
11/03/2006
Last updated
02/13/2017
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