Healthcare Provider Details

I. General information

NPI: 1982537031
Provider Name (Legal Business Name): PAXTON STARRETT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E US HIGHWAY 20
MIDDLEBURY IN
46540-8504
US

IV. Provider business mailing address

23084 JOHNATHON CT
ELKHART IN
46516-8977
US

V. Phone/Fax

Practice location:
  • Phone: 574-825-2485
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number45023375A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: