MEDICARE: STAR PHARMACY 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy	50025	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5635454	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1477785699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAR PHARMACY INC

Provider Business Mailing Address
First Line	:	7777 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-3911
Country	:	US
Telephone Number	:	323-850-6001
Fax Number	:	323-850-6005

Provider Business Practice Location Address
First Line	:	7777 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-3911
Country	:	US
Telephone Number	:	323-850-6001
Fax Number	:	323-850-6005

Authorized Official
Title or Position	:	MANAGER
Name	:	LUSINE HAKOBYAN
Credential	:
Telephone Number	:	323-850-6001

Provider Enumeration Date	:	08/21/2009
Last Update Date	:	08/02/2010

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Directions to “STAR PHARMACY INC ” Practice Location

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