MEDICARE: ST. MARYS PHARMACY, INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	332BC3200X	Customized Equipment (DME)
3	332BN1400X	Nursing Facility Supplies (DME)
4	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
5	3336C0003X	Community/Retail Pharmacy	PP481849	PA
6	332BX2000X	Oxygen Equipment & Supplies (DME)

General Provider Information

NPI Number	:	1619149622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. MARYS PHARMACY, INC.

Provider Business Mailing Address
First Line	:	4 RAILROAD STREET
Second Line	:
City	:	ST. MARYS
State	:	PA
Zip	:	15857-1729
Country	:	US
Telephone Number	:	814-834-2225
Fax Number	:	814-834-5383

Provider Business Practice Location Address
First Line	:	190 N FRALEY ST STE 2
Second Line	:
City	:	KANE
State	:	PA
Zip	:	16735-1165
Country	:	US
Telephone Number	:	814-837-8500
Fax Number	:	814-690-2114

Authorized Official
Title or Position	:	CFO/SEC
Name	:	MR. FRANCIS XAVIER STRAUB III
Credential	:	R.PH.
Telephone Number	:	814-834-2225

Provider Enumeration Date	:	03/31/2008
Last Update Date	:	09/19/2018

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Directions to “ST. MARYS PHARMACY, INC. ” Practice Location

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