=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306080635
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARLEM STAR PHARMACY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2009
-----------------------------------------------------
Last Update Date | 11/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 67 W 137TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10037-1953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-926-7500
-----------------------------------------------------
Fax | 212-926-5900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 67 W 137TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10037-1953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-926-7500
-----------------------------------------------------
Fax | 212-926-5900
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SATYA DASARI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 212-926-7500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 029425
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------