=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184937427
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLSTAR PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2010
-----------------------------------------------------
Last Update Date | 12/21/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11410 E. I-10 FREEWAY SUITE 164
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-590-0448
-----------------------------------------------------
Fax | 713-590-0447
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11410 E. I-10 FREEWAY SUITE 164
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-590-0448
-----------------------------------------------------
Fax | 713-590-0447
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ROBIN VINSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-590-0448
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 3336C0004X
-----------------------------------------------------
Taxonomy Name | Compounding Pharmacy
-----------------------------------------------------
License Number | 27115
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------