Provider Demographics
NPI:1619149622
Name:ST. MARYS PHARMACY, INC.
Entity Type:Organization
Organization Name:ST. MARYS PHARMACY, INC.
Other - Org Name:SMP HOME MEDICAL KANE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/SEC
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:XAVIER
Authorized Official - Last Name:STRAUB
Authorized Official - Suffix:III
Authorized Official - Credentials:RPH
Authorized Official - Phone:814-834-2225
Mailing Address - Street 1:4 RAILROAD STREET
Mailing Address - Street 2:
Mailing Address - City:ST. MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-1729
Mailing Address - Country:US
Mailing Address - Phone:814-834-2225
Mailing Address - Fax:814-834-5383
Practice Address - Street 1:190 N FRALEY ST STE 2
Practice Address - Street 2:
Practice Address - City:KANE
Practice Address - State:PA
Practice Address - Zip Code:16735-1165
Practice Address - Country:US
Practice Address - Phone:814-837-8500
Practice Address - Fax:814-690-2114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BC3200X, 332BN1400X, 332BP3500X, 332BX2000X
PAPP4818493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0235770002Medicare NSC