Provider Demographics
NPI:1437569126
Name:ST CHARLES PHARMACY LLC
Entity Type:Organization
Organization Name:ST CHARLES PHARMACY LLC
Other - Org Name:ST CHARLES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARUTHI
Authorized Official - Middle Name:PRASAD
Authorized Official - Last Name:VEERAMARCHNANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-932-5060
Mailing Address - Street 1:1152 SMALLWOOD DR W
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4759
Mailing Address - Country:US
Mailing Address - Phone:301-932-5060
Mailing Address - Fax:
Practice Address - Street 1:1152 SMALLWOOD DR W
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4759
Practice Address - Country:US
Practice Address - Phone:301-932-5060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy