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General NPI Number Information
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NPI Number | 1861556458
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Entity Type | Organization
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Legal Business Name | DAYSTAR PHARMACY INC
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 12/11/2009
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Provider Practice Location Address
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Address Line | 3926 BAHLER AVE
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City | MANVEL
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State | TX
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Zip | 77578-2823
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Country | US
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Telephone | 281-489-9409
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Fax | 281-489-4035
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Provider Business Mailing Address
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Address Line | PO BOX 307
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City | LAKE JACKSON
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State | TX
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Zip | 77566-0307
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PIC
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Name | LAUREN MCCREARY
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Credential | BS IN PHARMACY
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Telephone | 281-489-9409
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 14613
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License Number State | TX
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