Guardian Pharmacy of Madison, LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

GUARDIAN PHARMACY OF MADISON, LLC

Practice address

11420 W Theodore Trecker Way
West Allis, WI 53214-1137

Phone

(414) 727-5750

Fax

(414) 727-5770

NPI assigned

Oct 11, 2018

Organization subpart

No

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

Authorized official

Name

John Mike Flint

Title

DO

Phone

(414) 727-5750

Specialties & licenses 1

Addresses

Other names 1

• Guardian Pharmacy of Wisconsin Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WI2 enrollments

Enrollment records 2

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Guardian Pharmacy of Madison, LLC

  • Long Term Care Pharmacy
  • Madison, WI
  • NPI 1043707987

  5092064113

  Same PAC ID

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

Medicare medical equipment & supply locations

Tax ID family

Guardian Pharmacy of Madison LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Guardian Pharmacy of Madison, LLC

  • Long Term Care Pharmacy
  • Madison, WI
  • NPI 1043707987
  NPD tax ID

Locations

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Saint John'S Communities, Inc.

  • Skilled Nursing Facility
  • Milwaukee, WI
  • NPI 1295866325

  Adp of the SNF

  CMS ownership

Practitioners 1

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

• Lisa M Randolph, PHARMD

  • Pharmacist
  • West Allis, WI
  • NPI 1497537070
  NPD

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

{
    "created_epoch": "1539216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666310400000",
    "number": "1578038022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11420 W THEODORE TRECKER WAY",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532141137",
            "telephone_number": "414-727-5750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11420 W THEODORE TRECKER WAY",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532141137",
            "telephone_number": "414-727-5750",
            "fax_number": "414-727-5770"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10233 W Greenfield Ave",
            "address_purpose": "LOCATION",
            "city": "West Allis",
            "state": "WI",
            "postal_code": "532143911",
            "country_code": "US",
            "telephone_number": "414-727-5750",
            "fax_number": "414-727-5770",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GUARDIAN PHARMACY OF MADISON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-11",
        "last_updated": "2022-10-21",
        "certification_date": "2022-10-21",
        "status": "A",
        "authorized_official_last_name": "FLINT",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "MIKE",
        "authorized_official_title_or_position": "DO",
        "authorized_official_telephone_number": "414-727-5750"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://guardianpharmacyheartland.com/",
            "affiliation": "N",
            "endpointDescription": "Health Information Exchange (HIE)",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "HIE",
            "address_1": "11420 W Theodore Trecker Way",
            "city": "West Allis",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532141137",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Guardian Pharmacy of Wisconsin",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rebecca Joylyn Groves, COUNSELOR
• Growing Mindful Psychotherapy Creciendo Plenamente, LLC
• Emma Gruen, RN
• Thomas Grulkowski
• Janet Gruner, RN CNM
• Guy Enterprises, LLC
• Sieanna Mae Haakenson
• Sarah Elizabeth Haapakoski, APNP
• Patricia Ivonne Hago, M.D.
• Madison Jenean Hales

• Long Term Care Pharmacy in West Allis, WI
• Providers in West Allis, WI by specialty
• Long Term Care Pharmacy in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.