Provider Demographics
NPI:1255102166
Name:ST. MARY'S PHARMACY
Entity type:Organization
Organization Name:ST. MARY'S PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNDEN
Authorized Official - Last Name:HAMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:276-346-8850
Mailing Address - Street 1:5626 PATRIOT DR
Mailing Address - Street 2:
Mailing Address - City:WISE
Mailing Address - State:VA
Mailing Address - Zip Code:24293-1138
Mailing Address - Country:US
Mailing Address - Phone:276-328-8850
Mailing Address - Fax:
Practice Address - Street 1:5626 PATRIOT DR
Practice Address - Street 2:
Practice Address - City:WISE
Practice Address - State:VA
Practice Address - Zip Code:24293-1138
Practice Address - Country:US
Practice Address - Phone:276-328-8850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. MARY'S HEALTH WAGON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy