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General NPI Number Information
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NPI Number | 1619314606
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Entity Type | Organization
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Legal Business Name | FOUR STAR RX INC
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Dates
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Enumeration Date | 05/30/2013
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Last Update Date | 05/30/2013
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Provider Practice Location Address
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Address Line | 1835 N BROADWAY AVE SUITE 101
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City | MELROSE PARK
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State | IL
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Zip | 60160-2040
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Country | US
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Telephone | 732-421-6533
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Fax |
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Provider Business Mailing Address
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Address Line | 1835 N BROADWAY AVE SUITE 101
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City | MELROSE PARK
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State | IL
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Zip | 60160-2040
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Country | US
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Telephone | 732-421-6533
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DIPAK PATEL
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Credential | PHARMACIST
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Telephone | 732-421-6533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 054018207
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License Number State | IL
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