Organization
ST. MARY HEALTH VENTURES, INC.
Active
Parent organization
ST. MARY HEALTH VENTURES, INC.
Other names
MEDICAL MALL PHARMACY
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST. MARY HEALTH VENTURES, INC.
Authorized official
HAROLD WAY (CHIEF FINANCIAL OFFICER)
(562) 491-9929
Entity
Organization
Contact information
Practice address
1043 ELM AVE, SUITE 305, LONG BEACH, CA 90813-3271
(562) 491-9001
(562) 495-9651
Mailing address
1043 ELM AVE, SUITE 305, LONG BEACH, CA 90813-3271
(562) 491-9003
(562) 495-9651
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
50612
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0582014
NCPDP
—
05
—
PHA41010A
—
CA
Enumeration date
03/20/2007
Last updated
09/23/2013
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