Saint-Mark Enterprises 106 LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SAINT-MARK ENTERPRISES 106 LLC

Doing business as

Medicine Shoppe

Practice address

207 Professional Way
Shelton, WA 98584-4404

Phone

(360) 426-4272

Fax

(360) 426-6977

NPI assigned

Mar 3, 2009

Last updated

Jun 30, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mark A Miller

Title

Owner

Phone

(314) 518-2427

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MEDICINE SHOPPE Doing business as

Medicare fee-for-service enrollment

Enrolled in WA2 enrollments

Enrollment records 2

Locations

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

{
    "created_epoch": "1236038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1246320000000",
    "number": "1417197567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 98",
            "city": "EUREKA",
            "state": "MO",
            "postal_code": "630250098",
            "telephone_number": "314-518-2427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 PROFESSIONAL WAY",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985844404",
            "telephone_number": "360-426-4272",
            "fax_number": "360-426-6977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT-MARK ENTERPRISES 106 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-03",
        "last_updated": "2009-06-30",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-518-2427"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6032221",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICINE SHOPPE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Danielle Gavin Rylander, LMHC-A
• Elena Saeli
• Safeway Inc (Safeway Pharmacy #0585)
• Beatrice Elizabeth Safford
• Jennifer A Sagen
• Krystle Salzer
• Theresa M Samson
• Susan Diane Sannes
• Amylynne Sargent, MOTR/L
• Mark Luther Schlauderaff, M.D.

• Community/Retail Pharmacy in Shelton, WA
• Providers in Shelton, WA by specialty
• Community/Retail Pharmacy in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2009; 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.