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General NPI Number Information
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NPI Number | 1174280911
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Entity Type | Organization
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Legal Business Name | ST. MARY AND ST. ANTHONY LLC
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Dates
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Enumeration Date | 11/28/2021
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Last Update Date | 11/28/2021
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Provider Practice Location Address
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Address Line | 595 21ST ST UNIT 100
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City | VERO BEACH
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State | FL
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Zip | 32960-5449
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Country | US
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Telephone | 772-713-9303
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Fax | 772-448-4064
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Provider Business Mailing Address
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Address Line | 2190 3RD LN SW
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City | VERO BEACH
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State | FL
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Zip | 32962-3372
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Country | US
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Telephone | 772-713-9303
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Fax |
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Authorized Official
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Title or Position | OWNER/MGR
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Name | MICHAEL MARZOUK
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Credential |
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Telephone | 772-713-9303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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