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General NPI Number Information
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NPI Number | 1952994204
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Entity Type | Organization
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Legal Business Name | SAINT MARY MEDICAL
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Dates
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Enumeration Date | 02/18/2021
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Last Update Date | 07/30/2021
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Provider Practice Location Address
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Address Line | 4651 BABCOCK ST NE STE 5A
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City | PALM BAY
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State | FL
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Zip | 32905-2808
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Country | US
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Telephone | 347-309-1829
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Fax |
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Provider Business Mailing Address
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Address Line | 1332 LEXINGTON SQ SW
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City | VERO BEACH
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State | FL
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Zip | 32962-3411
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Country | US
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Telephone | 347-309-1829
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Fax |
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Authorized Official
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Title or Position | MANGER
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Name | MARINA BAKHET
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Credential |
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Telephone | 347-309-1829
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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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