NPIMap

Organization Active NPI

Guardian Healthcare Pharmacy, LLC

  • Long Term Care Pharmacy
  • Brockway, PA
National Provider Identifier
1316952948
Registry record updated Nov 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
PP481523 Issued in PA
Legal business name
GUARDIAN HEALTHCARE PHARMACY, LLC
Practice address
123 Brubaker Rd
Brockway, PA 15824-2505
Phone
(888) 503-7474
Fax
(877) 371-5677
NPI assigned
Jul 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2019

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

Authorized official

Name
Matthew J Varacallo, PHARM DNPI 1669702692
Title
Pharmacy Manager
Phone
(888) 503-7474

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Institutional Pharmacy 3336I0012X
Long Term Care Pharmacy 3336L0003X PP481523 PA Primary

Addresses

Primary practice location

123 Brubaker Rd
Brockway, PA 15824-2505

Mailing address

123 Brubaker Rd
Brockway, PA 15824-2505
Phone (888) 503-7474

Other identifiers 3

IdentifierTypeStateIssuer
1015064750001MedicaidPA
02163160000014708MedicaidOH
2087733OtherPK

Other names 3

  • GUARDIAN HEALTHCARE PHARMACY, LLC Doing business as
  • GUARDIAN LONG TERM CARE PHARMACY, INC Former legal business name
  • GUARDIAN HEALTHCARE PHARMACY Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573689600000",
    "number": "1316952948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 BRUBAKER RD",
            "city": "BROCKWAY",
            "state": "PA",
            "postal_code": "158242505",
            "telephone_number": "888-503-7474",
            "fax_number": "877-371-5677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 BRUBAKER RD",
            "city": "BROCKWAY",
            "state": "PA",
            "postal_code": "158242505",
            "telephone_number": "888-503-7474",
            "fax_number": "877-371-5677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUARDIAN HEALTHCARE PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2019-11-14",
        "status": "A",
        "authorized_official_last_name": "VARACALLO",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "888-503-7474",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "PA",
            "license": "PP481523",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1015064750001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02163160000014708",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2087733",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GUARDIAN HEALTHCARE PHARMACY, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GUARDIAN LONG TERM CARE PHARMACY, INC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "GUARDIAN HEALTHCARE PHARMACY",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Brockway, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.