Organization
ST MARKS PHARMACY LLC
Active
Other names
ST MARKS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
WAGIH MANKARIOUS (OWNER/PRESIDENT)
(813) 751-7630
Entity
Organization
Contact information
Practice address
4954 RIDGEMOOR BLVD, PALM HARBOR, FL 34685-1744
(727) 772-7070
(727) 772-7010
Mailing address
4954 RIDGEMOOR BLVD, PALM HARBOR, FL 34685-1744
(727) 772-7070
(727) 772-7010
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH23402
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2005602
PK
—
Enumeration date
06/11/2008
Last updated
02/20/2017
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