St Luke Pharmacy Corp

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH25416 Issued in FL

Legal business name

ST LUKE PHARMACY CORP

Practice address

2019 Gulf to Bay Blvd
Clearwater, FL 33765-3703

Phone

(727) 754-7851

Fax

(727) 754-7852

NPI assigned

May 11, 2012

Organization subpart

No

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

Authorized official

Name

John Musallam

Title

President

Phone

(727) 754-7851

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• ST Luke Pharmacy Doing business as

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

{
    "created_epoch": "1336694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436745600000",
    "number": "1831458868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2019 GULF TO BAY BLVD",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337653703",
            "telephone_number": "727-754-7851",
            "fax_number": "727-754-7852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2019 GULF TO BAY BLVD",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337653703",
            "telephone_number": "727-754-7851",
            "fax_number": "727-754-7852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LUKE PHARMACY CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-11",
        "last_updated": "2015-07-13",
        "status": "A",
        "authorized_official_last_name": "MUSALLAM",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "727-754-7851"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH25416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008099500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2135137",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ST Luke Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Keva St. Fort, BSW
• Ellen Marie St. John, MS, CCC-SLP
• Patricia St. John, M.D.

• Community/Retail Pharmacy in Clearwater, FL
• Providers in Clearwater, 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 Jul 13, 2015; 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.