Provider Demographics
NPI:1770988362
Name:ST JAMES LONG TERM CARE PHARMACY
Entity type:Organization
Organization Name:ST JAMES LONG TERM CARE PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER, CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:LIM
Authorized Official - Last Name:MARASIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-662-3865
Mailing Address - Street 1:20616 N CAVE CREEK RD STE 111
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-4451
Mailing Address - Country:US
Mailing Address - Phone:480-662-3865
Mailing Address - Fax:602-354-4336
Practice Address - Street 1:20616 N CAVE CREEK RD STE 111
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-4451
Practice Address - Country:US
Practice Address - Phone:480-662-3865
Practice Address - Fax:480-494-8558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-26
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS013212183500000X
AZT042375183700000X
AZY0062543336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Multi-Specialty