MEDICARE: TAINO 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	3336C0003X	Community/Retail Pharmacy	028756	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3348009	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558468496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAINO STAR PHARMACY, INC.

Provider Business Mailing Address
First Line	:	2403 2ND AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10035-2102
Country	:	US
Telephone Number	:	212-289-2000
Fax Number	:	212-289-5992

Provider Business Practice Location Address
First Line	:	2403 2ND AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10035-2102
Country	:	US
Telephone Number	:	212-289-2000
Fax Number	:	212-289-5992

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SATYA DASARI
Credential	:
Telephone Number	:	212-289-2000

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	12/17/2015

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