Healthcare Provider Details

I. General information

NPI: 1144207770
Provider Name (Legal Business Name): STARK PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2005
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1583 GOODMAN AVE
CINCINNATI OH
45224-1004
US

IV. Provider business mailing address

1583 GOODMAN AVE
CINCINNATI OH
45224-1004
US

V. Phone/Fax

Practice location:
  • Phone: 513-729-3800
  • Fax: 513-729-0383
Mailing address:
  • Phone: 513-729-3800
  • Fax: 513-729-0383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: THOMAS F STARK
Title or Position: PHARMACIST OWNER
Credential: RPH
Phone: 513-729-3800