Healthcare Provider Details

I. General information

NPI: 1710002860
Provider Name (Legal Business Name): ST. MARY HEALTH VENTURES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 ELM AVE SUITE 305
LONG BEACH CA
90813-3271
US

IV. Provider business mailing address

1043 ELM AVE SUITE 305
LONG BEACH CA
90813-3271
US

V. Phone/Fax

Practice location:
  • Phone: 562-491-9001
  • Fax: 562-495-9651
Mailing address:
  • Phone: 562-491-9003
  • Fax: 562-495-9651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number50612
License Number StateCA

VIII. Authorized Official

Name: HAROLD WAY
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 562-491-9929