Organization
SAINT-MARK ENTERPRISES #1153 LLC
Active
Other names
The Medicine Shoppe Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RIK ST GERMAIN (OWNER)
(206) 650-5514
Entity
Organization
Contact information
Practice address
1001 W 11TH ST, COFFEYVILLE, KS 67337-4220
(620) 251-2150
(620) 251-0022
Mailing address
1070 VIA SAINT LUCIA PL, HENDERSON, NV 89011-0873
(206) 650-5541
(702) 568-8676
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
2-10431
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2138312
PK
—
Enumeration date
11/20/2012
Last updated
07/05/2016
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