Healthcare Provider Details

I. General information

NPI: 1306854385
Provider Name (Legal Business Name): ST MARYS PHARMACIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 GATEWAY CENTER WAY STE A
SAN DIEGO CA
92102-4533
US

IV. Provider business mailing address

610 GATEWAY CENTER WAY STE A
SAN DIEGO CA
92102-4533
US

V. Phone/Fax

Practice location:
  • Phone: 619-238-9501
  • Fax: 619-398-2929
Mailing address:
  • Phone: 619-238-9501
  • Fax: 619-398-2929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number46330
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GEORGE AWAD
Title or Position: OWNER
Credential:
Phone: 619-997-4702