Healthcare Provider Details

I. General information

NPI: 1932570447
Provider Name (Legal Business Name): STAR PHARMACY RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2015
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 GUADALUPE ST
GUADALUPE CA
93434-1316
US

IV. Provider business mailing address

830 GUADALUPE ST
GUADALUPE CA
93434-1316
US

V. Phone/Fax

Practice location:
  • Phone: 805-219-0770
  • Fax: 805-219-0772
Mailing address:
  • Phone: 805-219-0770
  • Fax: 805-219-0772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY53695
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SAMI BORAIE
Title or Position: PRESIDENT/PIC
Credential:
Phone: 805-720-7218