Healthcare Provider Details

I. General information

NPI: 1700527785
Provider Name (Legal Business Name): ST MARY S PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 E SHIELDS AVE STE 105
FRESNO CA
93726-6901
US

IV. Provider business mailing address

3150 E SHIELDS AVE STE 105
FRESNO CA
93726-6901
US

V. Phone/Fax

Practice location:
  • Phone: 559-223-9090
  • Fax: 559-223-9091
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. BARSEG ABANYAN
Title or Position: PHARMACIST IN CHARGE
Credential: PHARMD
Phone: 559-223-9090