Organization
SAINT MARY'S MEDICAL GROUP INC
Active
Organization
SAINT MARY'S MEDICAL GROUP INC
Active
Other names
Saint Mary's Outpatient Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
HELEN LIDHOLM (CEO/AO)
(775) 770-3230
Entity
Organization
Contact information
Practice address
6255 SHARLANDS AVE, RENO, NV 89523-2882
(775) 770-6672
(775) 770-6675
Mailing address
1801 W OLYMPIC BLVD, PASADENA, CA 91199-0001
(775) 770-6672
(775) 770-6675
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
ASC03452
NV
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2155059
PK
—
Enumeration date
07/30/2015
Last updated
12/23/2015
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