Provider Demographics
NPI:1366807695
Name:GUARDIAN PHARMACY OF MAINE LLC
Entity type:Organization
Organization Name:GUARDIAN PHARMACY OF MAINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:MRS
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:DOHERTY
Authorized Official - Last Name:OLAND
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:207-373-9077
Mailing Address - Street 1:3 BUSINESS PKWY STE 2
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-7390
Mailing Address - Country:US
Mailing Address - Phone:207-373-9077
Mailing Address - Fax:207-373-9088
Practice Address - Street 1:3 BUSINESS PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-7390
Practice Address - Country:US
Practice Address - Phone:207-373-9077
Practice Address - Fax:207-373-9088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5462313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility