Provider Demographics
NPI:1437717261
Name:ST MARY RX INC
Entity Type:Organization
Organization Name:ST MARY RX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAYKEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:WAHBA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:908-925-7700
Mailing Address - Street 1:213 W SAINT GEORGES AVE
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-3948
Mailing Address - Country:US
Mailing Address - Phone:908-925-7700
Mailing Address - Fax:908-925-7702
Practice Address - Street 1:213 W SAINT GEORGES AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-3948
Practice Address - Country:US
Practice Address - Phone:908-925-7700
Practice Address - Fax:908-925-7702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-05
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RS00772200OtherSTATE LICENSE