MEDICARE: ST. AUGUSTINE SERVICES CORP.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235128034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. AUGUSTINE SERVICES CORP.

Provider Business Mailing Address
First Line	:	7801 DETROIT AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-2813
Country	:	US
Telephone Number	:	216-634-7425
Fax Number	:

Provider Business Practice Location Address
First Line	:	7801 DETROIT AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-2813
Country	:	US
Telephone Number	:	216-634-7425
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY
Name	:	MR. EDMUNA A. CARTER
Credential	:	R.PH.
Telephone Number	:	216-634-7440

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	05/29/2024

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Directions to “ST. AUGUSTINE SERVICES CORP. ” Practice Location

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