MEDICARE: ST.MARY PHARMACY II

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	PH25222	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5703853	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881990265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST.MARY PHARMACY II

Provider Business Mailing Address
First Line	:	30606 US HIGHWAY 19 N
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-4414
Country	:	US
Telephone Number	:	727-773-9000
Fax Number	:	727-773-9001

Provider Business Practice Location Address
First Line	:	30606 US HIGHWAY 19 N
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-4414
Country	:	US
Telephone Number	:	727-773-9000
Fax Number	:	727-773-9001

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MARKO SHAKER
Credential	:
Telephone Number	:	727-773-9000

Provider Enumeration Date	:	02/02/2011
Last Update Date	:	03/24/2016

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