Healthcare Provider Details

I. General information

NPI: 1790945640
Provider Name (Legal Business Name): ST LUKES HOMESTAR SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OSTRUM ST STE 101 A
BETHLEHEM PA
18015-1000
US

IV. Provider business mailing address

801 OSTRUM ST STE 101 A
BETHLEHEM PA
18015-1000
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-7500
  • Fax: 484-526-5199
Mailing address:
  • Phone: 484-526-7500
  • Fax: 484-526-5199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP481615
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH BORGIONI
Title or Position: ADMINISTRATOR
Credential: PHARMACIST
Phone: 484-526-7650