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General NPI Number Information
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NPI Number | 1902197841
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Entity Type | Organization
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Legal Business Name | TRI STAR MEDICAL PHARMACY LLC
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Dates
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Enumeration Date | 04/26/2011
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Last Update Date | 07/05/2011
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Provider Practice Location Address
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Address Line | 2845 CAPITAL AVE SW SUITE 301
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City | BATTLE CREEK
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State | MI
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Zip | 49015-4185
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Country | US
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Telephone | 269-979-5402
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Fax | 269-979-5609
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Provider Business Mailing Address
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Address Line | 2845 CAPITAL AVE SW SUITE 301
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City | BATTLE CREEK
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State | MI
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Zip | 49015-4185
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Country | US
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Telephone | 269-979-5402
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Fax | 269-979-5609
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Authorized Official
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Title or Position | OWNER
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Name | NANDAN PATEL
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Credential |
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Telephone | 734-673-7829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301009565
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License Number State | MI
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