Provider Demographics
NPI:1790775633
Name:SAINT MARY'S PHARMACY, INC.
Entity Type:Organization
Organization Name:SAINT MARY'S PHARMACY, INC.
Other - Org Name:LEXINGTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:EMEEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:METTIAS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:732-881-6355
Mailing Address - Street 1:3 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5037
Mailing Address - Country:US
Mailing Address - Phone:732-432-0999
Mailing Address - Fax:732-432-0299
Practice Address - Street 1:3 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5037
Practice Address - Country:US
Practice Address - Phone:732-432-0999
Practice Address - Fax:732-432-0299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-23
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4990333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6301509Medicaid
NJ6301509Medicaid