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Contact Information

GUARDIAN PHARMACY OF SOUTHEAST GA LLC
10929 HWY 301 SOUTH
STE 110 111
STATESBORO, GA30458
 Phone: 912-764-7839
 Fax: 912-489-1519
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Long Term Care Pharmacy

3336L0003X 58 Medical Supply Company with Pharmacist
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for GUARDIAN PHARMACY OF SOUTHEAST GA LLC

NPI Number 1326078007
LBN Legal business name GUARDIAN PHARMACY OF SOUTHEAST GA LLC
Authorized official JODI DINELLO - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 07/05/2006
Last updated 10/12/2016 - About 10 years ago
Identifiers
GA License # PHRE008143
GA Medicaid 446858035A
Other 2013153 PK
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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