Healthcare Provider Details

I. General information

NPI: 1619248085
Provider Name (Legal Business Name): MICHAEL CHARLES STARR PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4363 PACIFIC ST
ROCKLIN CA
95677-2117
US

IV. Provider business mailing address

18593 JOSEPH DR
GRASS VALLEY CA
95949-7210
US

V. Phone/Fax

Practice location:
  • Phone: 916-632-7560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number61121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: