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General NPI Number Information
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NPI Number | 1710002860
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Entity Type | Organization
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Legal Business Name | ST. MARY HEALTH VENTURES, INC.
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 09/23/2013
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Provider Practice Location Address
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Address Line | 1043 ELM AVE SUITE 305
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City | LONG BEACH
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State | CA
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Zip | 90813-3271
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Country | US
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Telephone | 562-491-9001
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Fax | 562-495-9651
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Provider Business Mailing Address
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Address Line | 1043 ELM AVE SUITE 305
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City | LONG BEACH
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State | CA
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Zip | 90813-3271
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Country | US
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Telephone | 562-491-9003
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Fax | 562-495-9651
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | HAROLD WAY
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Credential |
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Telephone | 562-491-9929
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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 | 50612
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License Number State | CA
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