Healthcare Provider Details

I. General information

NPI: 1184639700
Provider Name (Legal Business Name): ALL STAR PHARMACIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 11/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4969 US HIGHWAY 98 N
LAKELAND FL
33809-3657
US

IV. Provider business mailing address

PO BOX 2969
LAKELAND FL
33806-2969
US

V. Phone/Fax

Practice location:
  • Phone: 863-858-4444
  • Fax: 863-858-4832
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH22409
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DUANE MCKOWN
Title or Position: PRESIDENT
Credential:
Phone: 863-858-4444