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General NPI Number Information
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NPI Number | 1710105531
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Entity Type | Organization
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Legal Business Name | ST. MARY'S MPP
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 10860 N MAVINEE DR
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City | ORO VALLEY
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State | AZ
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Zip | 85737-9526
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Country | US
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Telephone | 520-297-3800
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Fax | 520-297-3466
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Provider Business Mailing Address
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Address Line | 10860 N MAVINEE DR
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City | ORO VALLEY
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State | AZ
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Zip | 85737-9526
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Country | US
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Telephone | 520-297-3800
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Fax | 520-297-3466
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Authorized Official
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Title or Position | CEO PRESIDENT
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Name | JERALD R CACCIATORE
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Credential | R PH
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Telephone | 520-297-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 6870
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License Number State | AZ
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