Provider Demographics
NPI:1073025607
Name:ST MARY PHARMACEUTICAL CORP
Entity Type:Organization
Organization Name:ST MARY PHARMACEUTICAL CORP
Other - Org Name:SHERMAN WAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKOGOSYAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:818-453-8380
Mailing Address - Street 1:15333 SHERMAN WAY STE C
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4204
Mailing Address - Country:US
Mailing Address - Phone:818-453-8380
Mailing Address - Fax:818-453-8362
Practice Address - Street 1:15333 SHERMAN WAY STE C
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-4204
Practice Address - Country:US
Practice Address - Phone:818-453-8380
Practice Address - Fax:818-453-8362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-05
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy