Saint-Mark Enterprises 1788 LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SAINT-MARK ENTERPRISES 1788 LLC

Practice address

11 E H St
Suite a
Deer Park, WA 99006-7178

Phone

(509) 276-5081

NPI assigned

Mar 3, 2009

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

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": "1790925840",
    "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": "509-276-5081",
            "fax_number": "509-276-7653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 E H ST",
            "address_2": "SUITE A",
            "city": "DEER PARK",
            "state": "WA",
            "postal_code": "990067178",
            "telephone_number": "509-276-5081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT-MARK ENTERPRISES 1788 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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6032213",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICINE SHOPPE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Selina Marie Ross, ARNP
• Corinna Renee Rozelle, PTA
• Shelby Renae Rush, MD
• Ryan L Bates DDS PS
• Breanna Sager, ARNP
• Mary Jane Sandall, RD, CD
• Robert Schryer, DDS
• Pamela Schultz-Torosian, DO
• Alex Socrates Schulz, PHARMD
• Cylee Scott

• Community/Retail Pharmacy in Deer Park, WA
• Providers in Deer Park, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.