Healthcare Provider Details

I. General information

NPI: 1497837298
Provider Name (Legal Business Name): STAR PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 W ELK AVE RM 10
DUNCAN OK
73533-5649
US

IV. Provider business mailing address

2340 W ELK AVE RM 10
DUNCAN OK
73533-5649
US

V. Phone/Fax

Practice location:
  • Phone: 580-255-7165
  • Fax: 580-255-0720
Mailing address:
  • Phone: 580-255-7165
  • Fax: 580-255-0720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number136164
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number136164
License Number StateOK

VIII. Authorized Official

Name: DR. BRIAN EDWARD BOBROVICZ
Title or Position: OWNER-PRES
Credential: PHARMD
Phone: 580-255-7165