Organization
ST JOHNS PHARMACY INC
Active
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
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