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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