Healthcare Provider Details

I. General information

NPI: 1225571243
Provider Name (Legal Business Name): STARCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E TREMONT AVE
BRONX NY
10453-5801
US

IV. Provider business mailing address

15 E TREMONT AVE
BRONX NY
10453-5801
US

V. Phone/Fax

Practice location:
  • Phone: 718-618-7525
  • Fax: 718-618-7526
Mailing address:
  • Phone: 718-618-7525
  • Fax: 718-618-7526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: KHAKIM KHAMDAMOV
Title or Position: OWNER
Credential:
Phone: 718-618-7525