MEDICARE: DE LA STAR PHARMACY

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	:	1598521551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DE LA STAR PHARMACY

Provider Business Mailing Address
First Line	:	1721 W MAGNOLIA BLVD
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91506-1839
Country	:	US
Telephone Number	:	818-566-7262
Fax Number	:	818-566-7500

Provider Business Practice Location Address
First Line	:	1721 W MAGNOLIA BLVD
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91506-1839
Country	:	US
Telephone Number	:	818-566-7262
Fax Number	:	818-566-7500

Authorized Official
Title or Position	:	CEO/OWNER/TECHNICIAN
Name	:	MS. AREG FAYROYAN
Credential	:
Telephone Number	:	818-566-7262

Provider Enumeration Date	:	02/26/2024
Last Update Date	:	02/29/2024

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Directions to “DE LA STAR PHARMACY ” Practice Location

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