MEDICARE: P STARK ENTERPRISES INC

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	3336C0003X	Community/Retail Pharmacy	4471	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4440979	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1356528848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	P STARK ENTERPRISES INC

Provider Business Mailing Address
First Line	:	1838 ELM HILL PIKE
Second Line	:	STE 125B
City	:	NASHVILLE
State	:	TN
Zip	:	37210-3726
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1838 ELM HILL PIKE
Second Line	:	STE 125B
City	:	NASHVILLE
State	:	TN
Zip	:	37210-3726
Country	:	US
Telephone Number	:	800-940-4901
Fax Number	:	888-208-1097

Authorized Official
Title or Position	:	OWNER
Name	:	PRESTON STARK
Credential	:
Telephone Number	:	615-585-4159

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	05/08/2009

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Directions to “P STARK ENTERPRISES INC ” Practice Location

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