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1255102166 NPI number — ST. MARY'S PHARMACY

NPI Number: 1255102166
Health Care Provider/Practitioner: ST. MARY'S PHARMACY

Information about “1255102166” NPI (ST. MARY'S PHARMACY) exists in 1255102166 in HTML format HTML  |  1255102166 in plain Text format TXT  |  1255102166 in PDF (Portable Document Format) PDF  |  1255102166 in an XML format XML  formats.

NPI Number : 1255102166 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1255102166",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "ST. MARY'S HEALTH WAGON",
    "ParentOrgTIN": null,
    "OrgName": "ST. MARY'S PHARMACY",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5626 PATRIOT DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WISE",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "24293-1138",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "276-328-8850",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5626 PATRIOT DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WISE",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "24293-1138",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "276-328-8850",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/10/2024",
    "LastUpdateDate": "01/10/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "HAMMONS",
    "AuthorizedOfficialFirstName": "JENNIFER",
    "AuthorizedOfficialMiddleName": "LYNDEN",
    "AuthorizedOfficialTitle": "PHARMACIST IN CHARGE",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PHARMD",
    "AuthorizedOfficialTelephoneNumber": "276-346-8850",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "3336C0002X",
        "TaxonomyName": "Clinic Pharmacy",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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