St Mary Corp Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY54161 Issued in CA

Legal business name

ST MARY CORP INC

Doing business as

Pharmacy of the Desert

Practice address

79440 Highway 111 Ste 103
La Quinta, CA 92253-4500

Phone

(760) 777-1115

Fax

(760) 777-1116

NPI assigned

Jan 31, 2016

Organization subpart

No

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

Authorized official

Name

Doris Khalil

Title

Owner, Secretary, Ao

Phone

(818) 357-0480

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Pharmacy of the Desert Doing business as

Locations

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

{
    "created_epoch": "1454198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493337600000",
    "number": "1699133041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "79440 HIGHWAY 111 STE 103",
            "city": "LA QUINTA",
            "state": "CA",
            "postal_code": "922534500",
            "telephone_number": "760-777-1115",
            "fax_number": "760-777-1116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "79440 HIGHWAY 111 STE 103",
            "city": "LA QUINTA",
            "state": "CA",
            "postal_code": "922534500",
            "telephone_number": "760-777-1115",
            "fax_number": "760-777-1116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST MARY CORP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-31",
        "last_updated": "2017-04-28",
        "status": "A",
        "authorized_official_last_name": "KHALIL",
        "authorized_official_first_name": "DORIS",
        "authorized_official_title_or_position": "OWNER, SECRETARY, AO",
        "authorized_official_telephone_number": "818-357-0480"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY54161",
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2157916",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pharmacy of the Desert",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Delos Soehren Jr., D.C.
• Rita Soto, DDA
• Nash Sourial, D.D.S.
• Kari Elizabeth Sower, NP
• Balachandran Dobli Srinivasan, MD, MD
• Parker Lewis Stanway, DMD
• Star Orthopaedics, Inc.
• Stephen Ross Steele, D.O.
• Kenneth Stein, PHARM D
• Steven P Gorman MD Inc.

• Community/Retail Pharmacy in La Quinta, CA
• Providers in La Quinta, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2017; 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.