Healthcare Provider Details

I. General information

NPI: 1649306531
Provider Name (Legal Business Name): STARCARE PHARMACY LLC DBA FORT LEWIS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2246 WEST MAIN ST
SALEM VA
24153
US

IV. Provider business mailing address

2246 WEST MAIN ST
SALEM VA
24153
US

V. Phone/Fax

Practice location:
  • Phone: 540-380-4681
  • Fax: 540-380-3221
Mailing address:
  • Phone: 540-380-4681
  • Fax: 540-380-3221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0201001938
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. KIRTESH PATEL
Title or Position: PRESIDENT
Credential: RPH
Phone: 540-537-5472