MEDICARE: ST MARY HEALTH 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	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1568327203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST MARY HEALTH LLC

Provider Business Mailing Address
First Line	:	30170 THREE NOTCH RD UNIT B
Second Line	:
City	:	CHARLOTTE HALL
State	:	MD
Zip	:	20622-4119
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30170 THREE NOTCH RD UNIT B
Second Line	:
City	:	CHARLOTTE HALL
State	:	MD
Zip	:	20622-4119
Country	:	US
Telephone Number	:	201-744-0481
Fax Number	:	240-448-3301

Authorized Official
Title or Position	:	PARTNER
Name	:	DIPEN PATEL
Credential	:	PHARMACIST
Telephone Number	:	201-744-0481

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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Directions to “ST MARY HEALTH LLC ” Practice Location

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