Provider Demographics
NPI:1780191858
Name:ST MARYS PHARMACY LLC
Entity Type:Organization
Organization Name:ST MARYS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RADHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:AKULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-475-2025
Mailing Address - Street 1:25482 POINT LOOKOUT RD BLDG 2
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-3895
Mailing Address - Country:US
Mailing Address - Phone:301-475-2025
Mailing Address - Fax:301-475-2026
Practice Address - Street 1:25482 POINT LOOKOUT RD BLDG 2
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-3895
Practice Address - Country:US
Practice Address - Phone:301-475-2025
Practice Address - Fax:301-475-2026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP056803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy