Provider Demographics
NPI:1083123236
Name:ST. MARYS PHARMACY INC
Entity Type:Organization
Organization Name:ST. MARYS PHARMACY INC
Other - Org Name:SMP HOME MEDICAL BROOKVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF HME
Authorized Official - Prefix:MR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:814-834-2225
Mailing Address - Street 1:4 RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-1729
Mailing Address - Country:US
Mailing Address - Phone:814-834-3017
Mailing Address - Fax:
Practice Address - Street 1:225 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825
Practice Address - Country:US
Practice Address - Phone:814-834-2225
Practice Address - Fax:814-834-6510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1000002309332B00000X
332BC3200X, 332BN1400X, 332BP3500X
PA3000009806332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007711390011Medicaid