St. Mary'S Pharmacy

Primary specialty

Clinic PharmacyTaxonomy code 3336C0002X

Legal business name

ST. MARY'S PHARMACY

Practice address

5626 Patriot Dr
Wise, VA 24293-1138

Phone

(276) 328-8850

NPI assigned

Jan 10, 2024

Organization subpart

Yes

Parent organization

ST. MARY'S HEALTH WAGONAs reported in NPPES

Name

Dr. Jennifer Lynden Hammons, PHARMD

Title

Pharmacist in Charge

Phone

(276) 346-8850

Tax ID family

St Mary'S Health Wagon Inc2 organizations share this tax ID, including this one

Part of

St Mary'S Health Wagon Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• St. Mary'S Health Wagon

  • Rural Health Clinic/Center
  • Clintwood, VA
  • NPI 1487818902
  NPD tax ID

Locations

• St. Mary's Health Wagon Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 10, 2024.

{
    "created_epoch": "1704844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704844800000",
    "number": "1255102166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 PATRIOT DR",
            "city": "WISE",
            "state": "VA",
            "postal_code": "242931138",
            "telephone_number": "276-328-8850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5626 PATRIOT DR",
            "city": "WISE",
            "state": "VA",
            "postal_code": "242931138",
            "telephone_number": "276-328-8850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARY'S PHARMACY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. MARY'S HEALTH WAGON",
        "enumeration_date": "2024-01-10",
        "last_updated": "2024-01-10",
        "certification_date": "2024-01-10",
        "status": "A",
        "authorized_official_last_name": "HAMMONS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "LYNDEN",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "276-346-8850",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Mary's Health Wagon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Angela Stallard Short, FNP
• Dawn Short, FNP
• Dana Sibrel, MA, ATC
• St. Mary'S Health Wagon
• St. Mary'S Health Wagon
• Olivia Stallard, DMD
• Autumn Marie Starnes, D.O.
• Chritsopher T. Starnes, M.D.
• Stephanie Strouth, LPC
• Erra Jo Sutherland, WHNP

• All providers in Wise, VA
• Clinic Pharmacy in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.