ST JOHNS PHARMACY INC (NPI# 1245397678) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1245397678 |
Entity Type | Organization |
Organization Name | ST JOHNS PHARMACY INC |
Other Organization Name | ST JOHNS PROGRESSIVE PHARMACY |
Practice Address |
24288 Three Notch Rd Hollywood MD 20636 |
Mailing Address |
Po Box 790 Hollywood MD 20636-0790 |
Practice Telephone | 3013733340 |
Practice Fax Number | 3013733691 |
Mailing Telephone | 3013733340 |
Mailing Fax Number | 3013733691 |
Enumeration Date | 2007-01-03 |
Last Update Date | 2012-12-26 |
Authorized Official Name | LEO MALLARD (OWNER) |
Authorized Official Telephone | 4107415150 |
Authorized Official Credential | RPH |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
N | 333600000X | Pharmacy | Suppliers | ||
N | 3336S0011X |
Pharmacy Specialization: Specialty Pharmacy |
Suppliers | ||
Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
P01320 | MD | Suppliers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
NCPDP PROVIDER IDENTIFICATION NUMBER | 2114421 | 01 | |
MD | 434192900 | 05 |
Other Name | Type Code |
---|---|
ST JOHNS PROGRESSIVE PHARMACY | Doing Business As Name - Organization |
Street Address |
24288 THREE NOTCH RD |
City | HOLLYWOOD |
State | MD |
Zip Code | 20636 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1518483452 | Rachel Werner | Pharmacist | 24288 Three Notch Rd, Hollywood, MD 20636-4628 | 2017-08-22 |
1326589060 | Sahar Kassem | Pharmacist | 24288 Three Notch Rd, Hollywood, MD 20636-4628 | 2017-03-14 |
1215394887 | Suzanne Moebius | Pharmacist | 24288 Three Notch Rd, Hollywood, MD 20636-4628 | 2016-01-26 |
1316340151 | Dheera Kapoor Semidey | Pharmacist | 24288 Three Notch Rd, Hollywood, MD 20636-4628 | 2014-10-08 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1841708427 | Lisa Early | Case Manager/Care Coordinator | 24077 John Cameron Way, Hollywood, MD 20636 | 2018-01-17 |
1326439365 | Maryland Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 24288 Three Notch Rd., Hollywood, MD 20636 | 2015-02-12 |
1972810612 | Kathleen Latona Boyles | Pharmacist | 24288 Three Notch Road, Hollywood, MD 20636 | 2010-09-01 |
1386825271 | Vijaya Guduri | Internal Medicine | 24035 Three Notch Road, Shah Associates Md LLC, Hollywood, MD 20636 | 2007-11-19 |
1194824755 | Julie Wilkening | Chiropractor | 24351 Mervell Dean Rd #115, Hollywood, MD 20636 | 2006-09-21 |
1225134281 | Mary Rice Hughes | Registered Nurse | 44101 Airport View Dr., Hollywood, MD 20636 | 2006-09-16 |
1376654194 | Suzanne Janis Pelz | Counselor | 44101 Airport View Drive, Hollywood, MD 20636 | 2006-08-31 |
1831406883 | Hanna Kristina Dennis | Physician Assistant | 24035 Three Notch Rd, Hollywood, MD 20636 | 2010-09-10 |
1750549010 | Iram A Khan | Internal Medicine | 24035 Three Notch Road, Hollywood, MD 20636 | 2008-05-22 |
1851473110 | John Elliott Walker | Registered Nurse | 44101 Airport View Drive, Hollywood, MD 20636 | 2006-10-19 |
Find all providers in zip 20636 |
Taxonomy Code | 3336C0003X |
Grouping | Suppliers |
Classification | Pharmacy |
Specialization | Community/Retail Pharmacy |
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
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1003083569 | White Orchid Pharmacy Inc | Pharmacy | 2328b Hollywood Blvd, Hollywood, FL 33020-1201 | 2008-05-14 |
1396837407 | Broward Pharmacy & Discount Store Inc | Pharmacy | 2323 N 60 Avenue, Hollywood, FL 33021 | 2006-09-28 |
1770687758 | Holiday Cvs LLC | Pharmacy | 6665 Taft St, Hollywood, FL 33024-4010 | 2006-09-12 |
1285738146 | Holiday Cvs LLC | Pharmacy | 4599 Sheridan St, Hollywood, FL 33021-3515 | 2006-09-12 |
1336243203 | Holiday Cvs LLC | Pharmacy | 901 N Federal Hwy, Hollywood, FL 33020-3537 | 2006-09-12 |
Find all providers in HOLLYWOOD |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.