Provider Demographics
NPI:1386036606
Name:ST MARYS PHARMACY LLC
Entity Type:Organization
Organization Name:ST MARYS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:AKULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-475-2024
Mailing Address - Street 1:25482 POINT LOOKOUT RD
Mailing Address - Street 2:BUILDING 2 UNIT 203C
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-3895
Mailing Address - Country:US
Mailing Address - Phone:301-475-2024
Mailing Address - Fax:301-475-2026
Practice Address - Street 1:25482 POINT LOOKOUT RD
Practice Address - Street 2:BUILDING 2 UNIT 203C
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-3895
Practice Address - Country:US
Practice Address - Phone:301-475-2024
Practice Address - Fax:301-475-2026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP05680M261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6972170001Medicare NSC