MEDICARE: ST. MARY AND ST. ANTHONY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396325684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. MARY AND ST. ANTHONY LLC

Provider Business Mailing Address
First Line	:	2220 3RD PL SW
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32962-3358
Country	:	US
Telephone Number	:	772-713-9303
Fax Number	:

Provider Business Practice Location Address
First Line	:	5045 TURNPIKE FEEDER RD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34951-2247
Country	:	US
Telephone Number	:	772-713-9303
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL MARZOUK
Credential	:
Telephone Number	:	772-713-9303

Provider Enumeration Date	:	04/10/2021
Last Update Date	:	04/10/2021

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