Provider Demographics
NPI:1326861170
Name:SAINT MARY LLC
Entity type:Organization
Organization Name:SAINT MARY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:YOUSEF
Authorized Official - Middle Name:
Authorized Official - Last Name:AGAYBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-283-8391
Mailing Address - Street 1:1036 OLD LOGAN RD
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-3355
Mailing Address - Country:US
Mailing Address - Phone:646-283-8391
Mailing Address - Fax:
Practice Address - Street 1:1036 OLD LOGAN RD
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3355
Practice Address - Country:US
Practice Address - Phone:304-896-2127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-31
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy