Provider Demographics
NPI:1306283072
Name:GUARDIAN PHARMACY OF KNOXVILLE LLC
Entity type:Organization
Organization Name:GUARDIAN PHARMACY OF KNOXVILLE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-684-9987
Mailing Address - Street 1:GUARDIAN PHARMACY OF TENNESSEE ONE DEPT 2441
Mailing Address - Street 2:P.O. BOX 11407
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-0001
Mailing Address - Country:US
Mailing Address - Phone:404-810-0089
Mailing Address - Fax:404-810-0094
Practice Address - Street 1:431 PARK VILLAGE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-3849
Practice Address - Country:US
Practice Address - Phone:865-730-4200
Practice Address - Fax:865-730-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-04
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN51883336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1306283072Medicaid
OK200642900AMedicaid
NV1306283072Medicaid
VA1306283072Medicaid
WY142751200Medicaid
2140656OtherPK
AL1306283072Medicaid
WV3810030160Medicaid
KY70100257410Medicaid
SC7T5188Medicaid
7443550001Medicare NSC