Provider Demographics
NPI:1992970768
Name:GARDA RX LLC
Entity type:Organization
Organization Name:GARDA RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:724-568-4144
Mailing Address - Street 1:1596 HANCOCK AVE
Mailing Address - Street 2:
Mailing Address - City:APOLLO
Mailing Address - State:PA
Mailing Address - Zip Code:15613-8404
Mailing Address - Country:US
Mailing Address - Phone:724-568-4144
Mailing Address - Fax:724-571-7605
Practice Address - Street 1:1596 HANCOCK AVE
Practice Address - Street 2:
Practice Address - City:APOLLO
Practice Address - State:PA
Practice Address - Zip Code:15613-8404
Practice Address - Country:US
Practice Address - Phone:724-568-4144
Practice Address - Fax:724-571-7628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4818183336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2082515OtherPK
PA1021327540002Medicaid