Organization
ST MARY CORP INC
Active
Other names
Pharmacy of the Desert
Organization subpart
No
Provider details
NPI number
Authorized official
DORIS KHALIL (OWNER, SECRETARY, AO)
(818) 357-0480
Entity
Organization
Contact information
Practice address
79440 HIGHWAY 111 STE 103, LA QUINTA, CA 92253-4500
(760) 777-1115
(760) 777-1116
Mailing address
79440 HIGHWAY 111 STE 103, LA QUINTA, CA 92253-4500
(760) 777-1115
(760) 777-1116
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY54161
CA
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2157916
PK
—
Enumeration date
01/31/2016
Last updated
04/28/2017
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