MEDICARE: BRIGHTSTAR HEALTH CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1114483559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTSTAR HEALTH CORP

Provider Business Mailing Address
First Line	:	5515 WALDOS BEACH RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28306-5505
Country	:	US
Telephone Number	:	910-491-1090
Fax Number	:

Provider Business Practice Location Address
First Line	:	5515 WALDOS BEACH RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28306-5505
Country	:	US
Telephone Number	:	910-491-1090
Fax Number	:

Authorized Official
Title or Position	:	OWNER PHARMACIST
Name	:	DEREK OTENG BOATENG
Credential	:
Telephone Number	:	910-491-1090

Provider Enumeration Date	:	02/11/2019
Last Update Date	:	02/11/2019

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Directions to “BRIGHTSTAR HEALTH CORP ” Practice Location

Language	Start Address	Practice Location

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