Healthcare Provider Details

I. General information

NPI: 1669511465
Provider Name (Legal Business Name): MEDSTAR PHARMACIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

PO BOX 418869
BOSTON MA
02241-8869
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-3772
  • Fax: 202-444-6476
Mailing address:
  • Phone: 410-540-4492
  • Fax: 410-579-8264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRX1200014
License Number StateDC

VIII. Authorized Official

Name: JOE SARACINO
Title or Position: MANAGER, ADMINISTRATIVE SERVICES
Credential:
Phone: 410-540-4492