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General NPI Number Information
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NPI Number | 1942772272
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Entity Type | Organization
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Legal Business Name | RISING STAR HOLDINGS LLC
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Dates
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Enumeration Date | 12/27/2018
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Last Update Date | 12/29/2023
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Provider Practice Location Address
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Address Line | 508 E GRAVIS ST
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City | SAN DIEGO
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State | TX
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Zip | 78384-2708
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Country | US
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Telephone | 361-209-8322
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Fax | 361-209-5022
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Provider Business Mailing Address
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Address Line | PO BOX 1488
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City | COPPELL
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State | TX
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Zip | 75019-1488
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Country | US
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Telephone | 361-209-8322
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Fax | 361-209-5022
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Authorized Official
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Title or Position | OFFICER
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Name | NANDANA KAVURI
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Credential |
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Telephone | 214-620-7220
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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 |
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License Number State |
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