Provider Demographics
NPI:1992924161
Name:ST MARYS MEDICAL PARK PHARMACY INC
Entity type:Organization
Organization Name:ST MARYS MEDICAL PARK PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-837-0146
Mailing Address - Street 1:10860 N MAVINEE DR
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-9526
Mailing Address - Country:US
Mailing Address - Phone:520-837-0120
Mailing Address - Fax:520-297-3466
Practice Address - Street 1:10860 N MAVINEE DR
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-9526
Practice Address - Country:US
Practice Address - Phone:520-837-0120
Practice Address - Fax:520-297-3466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6870183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty