Healthcare Provider Details

I. General information

NPI: 1255102166
Provider Name (Legal Business Name): ST. MARY'S PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5626 PATRIOT DR
WISE VA
24293-1138
US

IV. Provider business mailing address

5626 PATRIOT DR
WISE VA
24293-1138
US

V. Phone/Fax

Practice location:
  • Phone: 276-328-8850
  • Fax:
Mailing address:
  • Phone: 276-328-8850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER LYNDEN HAMMONS
Title or Position: PHARMACIST IN CHARGE
Credential: PHARMD
Phone: 276-346-8850