St Mary Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH23976 Issued in FL

Legal business name

ST MARY PHARMACY LLC

Practice address

1290 W Bay Dr
Largo, FL 33770-2204

Phone

(727) 585-1333

Fax

(727) 585-1344

NPI assigned

Apr 9, 2009

Organization subpart

No

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

Authorized official

Name

John Shaker

Title

Pharmacist (Partner)

Phone

(727) 637-8174

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• ST. MARY PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Networks

• Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)
• Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…

Practitioners 1

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

• Michael E Ibrahim

  • Critical Care Pharmacist
  • Largo, FL
  • NPI 1407353626
  NPD (past)

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

{
    "created_epoch": "1239235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487203200000",
    "number": "1740423573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1290 W BAY DR",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337702204",
            "telephone_number": "727-585-1333",
            "fax_number": "727-585-1344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1290 W BAY DR",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337702204",
            "telephone_number": "727-585-1333",
            "fax_number": "727-585-1344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST MARY PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-09",
        "last_updated": "2017-02-16",
        "status": "A",
        "authorized_official_last_name": "SHAKER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PHARMACIST (PARTNER)",
        "authorized_official_telephone_number": "727-637-8174"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH23976",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2119775",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001226300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ST. MARY PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Akshitha Sreeram, DPM
• Ashley Beth Srivastava, LCSW
• Sunit Srivastava, M.D.
• SST Medical Solutions, Inc.
• Peggy Ann St Croix, ARNP
• St Michaels Eye & Laser Institute Inc
• St Michaels Surgery Center Inc.
• St. Anthony'S Professional Buildings & Services, Inc
• Jiorel Troy St.Troix, LMT
• Johanna Stachurski

• Community/Retail Pharmacy in Largo, FL
• Providers in Largo, FL by specialty
• Community/Retail Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2017; 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.