MEDICARE: SAINT MARY MEDICAL

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	:	1952994204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAINT MARY MEDICAL

Provider Business Mailing Address
First Line	:	1332 LEXINGTON SQ SW
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32962-3411
Country	:	US
Telephone Number	:	347-309-1829
Fax Number	:

Provider Business Practice Location Address
First Line	:	4651 BABCOCK ST NE STE 5A
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-2808
Country	:	US
Telephone Number	:	347-309-1829
Fax Number	:

Authorized Official
Title or Position	:	MANGER
Name	:	MARINA BAKHET
Credential	:
Telephone Number	:	347-309-1829

Provider Enumeration Date	:	02/18/2021
Last Update Date	:	07/30/2021

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Directions to “SAINT MARY MEDICAL ” Practice Location

Language	Start Address	Practice Location

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