MEDICARE: ST MARYS HOSPITAL OF ST MARYS COUNTY, 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	333600000X	Pharmacy
2	3336I0012X	Institutional Pharmacy	P00738	MD

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
2	2033193	OTHER		PK

General Provider Information

NPI Number	:	1992722433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST MARYS HOSPITAL OF ST MARYS COUNTY, INC

Provider Business Mailing Address
First Line	:	PO BOX 527
Second Line	:
City	:	LEONARDTOWN
State	:	MD
Zip	:	20650-0527
Country	:	US
Telephone Number	:	301-475-6072
Fax Number	:	301-457-6075

Provider Business Practice Location Address
First Line	:	25500 POINT LOOKOUT RD
Second Line	:
City	:	LEONARDTOWN
State	:	MD
Zip	:	20650-2015
Country	:	US
Telephone Number	:	301-475-6072
Fax Number	:	301-475-6075

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY
Name	:	MARY IBEGBU
Credential	:	PHARMD
Telephone Number	:	301-475-6268

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/19/2018

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