Organization
ST. JAMES MTM PHARMACY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN MARASIGAN MD (DIRECTOR, LLC MANAGER)
(480) 662-3865
Entity
Organization
Contact information
Practice address
3954 E WALLER LN, PHOENIX, AZ 85050-4916
(480) 662-3865
Mailing address
20624 N CAVE CREEK RD STE 142, STE 142, PHOENIX, AZ 85024-4453
(480) 662-3865
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
S014670
AZ
208D00000X
General Practice Physician
MD47798
AZ
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
04/13/2017
Last updated
04/13/2017
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