NPIMap

Organization Active NPI

St. Mary Health Ventures, Inc.

Doing business as Medical Mall Pharmacy

  • Community/Retail Pharmacy
  • Long Beach, CA
National Provider Identifier
1710002860
Registry record updated Sep 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
50612 Issued in CA
Legal business name
ST. MARY HEALTH VENTURES, INC.
Doing business as
Medical Mall Pharmacy
Practice address
1043 Elm Ave
Suite 305
Long Beach, CA 90813-3271
Phone
(562) 491-9001
Fax
(562) 495-9651
NPI assigned
Mar 20, 2007
Organization subpart
Yes
Parent organization
ST. MARY HEALTH VENTURES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 23, 2013

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

Authorized official

Name
Harold Way
Title
Chief Financial Officer
Phone
(562) 491-9929

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 50612 CA Primary

Addresses

Primary practice location

1043 Elm Ave
Suite 305
Long Beach, CA 90813-3271

Mailing address

1043 Elm Ave
Suite 305
Long Beach, CA 90813-3271
Phone (562) 491-9003

Other identifiers 2

IdentifierTypeStateIssuer
PHA41010AMedicaidCA
0582014OtherNCPDP

Other names 1

  • MEDICAL MALL PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
St Mary Health Ventures Inc2 organizations share this tax ID, including this one
Part of
St Mary Health Ventures Inc

Other organizations with this tax ID 1

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

Locations

1043 Elm Ave
Ste 305
Long Beach, CA 90813
Phone (562) 491-9001

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379894400000",
    "number": "1710002860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1043 ELM AVE",
            "address_2": "SUITE 305",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908133271",
            "telephone_number": "562-491-9003",
            "fax_number": "562-495-9651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1043 ELM AVE",
            "address_2": "SUITE 305",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908133271",
            "telephone_number": "562-491-9001",
            "fax_number": "562-495-9651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARY HEALTH VENTURES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. MARY HEALTH VENTURES, INC.",
        "enumeration_date": "2007-03-20",
        "last_updated": "2013-09-23",
        "status": "A",
        "authorized_official_last_name": "WAY",
        "authorized_official_first_name": "HAROLD",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "562-491-9929"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "50612",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA41010A",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "0582014",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICAL MALL PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Long Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2013; 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.