Guardian Pharmacy of Tulsa, LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

2-7811 Issued in OK

Legal business name

GUARDIAN PHARMACY OF TULSA, LLC

Practice address

5415 S 125TH East Ave
Suite 201-203
Tulsa, OK 74146-6232

Phone

(866) 237-8217

Fax

(855) 711-3900

NPI assigned

Feb 26, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ricky Burgess

Title

President

Phone

(866) 237-8217

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Boomer Solutions of Tulsa Doing business as

Medicare fee-for-service enrollment

Enrolled in OK3 enrollments

Enrollment records 3

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Guardian Pharmacy of Oklahoma LLC

  • Long Term Care Pharmacy
  • Eufaula, OK
  • NPI 1083084768

  O20151208002458

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare medical equipment & supply locations

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1456444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487894400000",
    "number": "1194185504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11407",
            "address_2": "DEPT # 2610",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352462610",
            "telephone_number": "404-810-0089",
            "fax_number": "404-810-0094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5415 S 125TH EAST AVE",
            "address_2": "SUITE 201-203",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741466232",
            "telephone_number": "866-237-8217",
            "fax_number": "855-711-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUARDIAN PHARMACY OF TULSA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-26",
        "last_updated": "2017-02-24",
        "status": "A",
        "authorized_official_last_name": "BURGESS",
        "authorized_official_first_name": "RICKY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "866-237-8217"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "OK",
            "license": "2-7811",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200611770C",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boomer Solutions of Tulsa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Meghan Grunhof
• Gsi ASC, LLC
• Gtoddmed PLLC
• Thangkhan K Gualnam, LPC
• Guardian Anesthesia Services, PC
• Rosa Linda Guardiola
• Anthony R Guariglia, MD
• Cara Guariglia, M.D.
• Mark Gubichuk, CRNA
• Dana Gudgel, M.A.

• Long Term Care Pharmacy in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Long Term Care Pharmacy in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.