Provider Demographics
NPI:1386420263
Name:ST LUKE PHARMACY LLC
Entity type:Organization
Organization Name:ST LUKE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MENA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTROS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:571-926-8786
Mailing Address - Street 1:46440 BENEDICT DR STE 103
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-6602
Mailing Address - Country:US
Mailing Address - Phone:571-926-8786
Mailing Address - Fax:571-325-2967
Practice Address - Street 1:46440 BENEDICT DR STE 103
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-6602
Practice Address - Country:US
Practice Address - Phone:571-926-8786
Practice Address - Fax:571-325-2967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-06
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy