MEDICARE: STARK PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3639880	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1144207770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STARK PHARMACY

Provider Business Mailing Address
First Line	:	1583 GOODMAN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-1004
Country	:	US
Telephone Number	:	513-729-3800
Fax Number	:	513-729-0383

Provider Business Practice Location Address
First Line	:	1583 GOODMAN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-1004
Country	:	US
Telephone Number	:	513-729-3800
Fax Number	:	513-729-0383

Authorized Official
Title or Position	:	PHARMACIST OWNER
Name	:	THOMAS F STARK
Credential	:	RPH
Telephone Number	:	513-729-3800

Provider Enumeration Date	:	12/24/2005
Last Update Date	:	02/14/2008

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Directions to “STARK PHARMACY ” Practice Location

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