Saint-Mark Enterprises 1196 LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2-10424 Issued in KS

Legal business name

SAINT-MARK ENTERPRISES 1196 LLC

Doing business as

The Medicine Shoppe Pharmacy

Practice address

1000 Adams St
Great Bend, KS 67530-4208

Phone

(620) 792-3030

Fax

(620) 792-4971

NPI assigned

Sep 25, 2012

Last updated

Nov 7, 2016By 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

Rik St Germain

Title

Owner

Phone

(206) 650-5514

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• The Medicine Shoppe Pharmacy Doing business as

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

{
    "created_epoch": "1348531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478476800000",
    "number": "1770834111",
    "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": "1000 ADAMS ST",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "675304208",
            "telephone_number": "620-792-3030",
            "fax_number": "620-792-4971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT-MARK ENTERPRISES 1196 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-25",
        "last_updated": "2016-11-07",
        "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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "KS",
            "license": "2-10424",
            "primary": true
        },
        {
            "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": "2137647",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Medicine Shoppe Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Great Bend, KS
• Providers in Great Bend, 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 Nov 7, 2016; 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.