Organization
ST JOHNS PHARMACY INC
Active
Other names
ST JOHNS PROGRESSIVE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
LEO MALLARD RPH (OWNER)
(410) 741-5150
Entity
Organization
Contact information
Practice address
24288 THREE NOTCH RD, HOLLYWOOD, MD 20636
(301) 373-3340
(301) 373-3691
Mailing address
PO BOX 790, HOLLYWOOD, MD 20636-0790
(301) 373-3340
(301) 373-3691
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P01320
MD
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2114421
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
434192900
—
MD
Enumeration date
01/03/2007
Last updated
12/26/2012
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us