Saint-Mark Enterprises #1153 LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2-10431 Issued in KS

Legal business name

SAINT-MARK ENTERPRISES #1153 LLC

Practice address

1001 W 11TH St
Coffeyville, KS 67337-4220

Phone

(620) 251-2150

Fax

(620) 251-0022

NPI assigned

Nov 20, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rik St Germain

Title

Owner

Phone

(206) 650-5514

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• The Medicine Shoppe Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John Isaacs

  • Pharmacist
  • Coffeyville, KS
  • NPI 1992250005
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1353369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467676800000",
    "number": "1346584935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1070 VIA SAINT LUCIA PL",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890110873",
            "telephone_number": "206-650-5541",
            "fax_number": "702-568-8676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 W 11TH ST",
            "city": "COFFEYVILLE",
            "state": "KS",
            "postal_code": "673374220",
            "telephone_number": "620-251-2150",
            "fax_number": "620-251-0022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT-MARK ENTERPRISES #1153 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-20",
        "last_updated": "2016-07-05",
        "status": "A",
        "authorized_official_last_name": "ST GERMAIN",
        "authorized_official_first_name": "RIK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-650-5514"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "KS",
            "license": "2-10431",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2138312",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Medicine Shoppe Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rebecca Dobbins, O.D., P.a.
• Garrick A Rettele, MD
• Jeffrey Wayne Rivers, PHARM.D.
• RJT Enterprises Inc.
• Russell E Robson
• Geeta Sandhu, M.D.
• Paul S Sandhu, M.D.
• Senior Healthcare, LLC
• Senior Services of Southeast Kansas Inc.
• Cole R Shawver

• Community/Retail Pharmacy in Coffeyville, KS
• Providers in Coffeyville, KS by specialty
• Community/Retail Pharmacy in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.