Healthcare Provider Details

I. General information

NPI: 1124983861
Provider Name (Legal Business Name): ST MARY HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30170 THREE NOTCH RD UNIT B
CHARLOTTE HALL MD
20622-4119
US

IV. Provider business mailing address

30170 THREE NOTCH RD UNIT B
CHARLOTTE HALL MD
20622-4119
US

V. Phone/Fax

Practice location:
  • Phone: 201-744-0481
  • Fax: 240-448-3301
Mailing address:
  • Phone: 201-744-0481
  • Fax: 240-448-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DIPEN PATEL
Title or Position: PARTNER
Credential: PHARMACIST
Phone: 201-744-0481