Healthcare Provider Details

I. General information

NPI: 1386633642
Provider Name (Legal Business Name): STAR DRUG CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 CALIMESA BLVD
CALIMESA CA
92320-1549
US

IV. Provider business mailing address

1151 CALIMESA BLVD
CALIMESA CA
92320-1549
US

V. Phone/Fax

Practice location:
  • Phone: 909-795-2457
  • Fax:
Mailing address:
  • Phone: 909-795-2457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY37324
License Number StateCA

VIII. Authorized Official

Name: MR. MICHAEL LOGAN
Title or Position: PRESIDENT
Credential: PHARMACIST
Phone: 909-795-2457