MEDICARE: FIVE STAR HEALTH SERVICES 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	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy	1185	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2123417	OTHER		PK

General Provider Information

NPI Number	:	1649501602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIVE STAR HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	9379 SWANSON BLVD STE E
Second Line	:
City	:	CLIVE
State	:	IA
Zip	:	50325-6942
Country	:	US
Telephone Number	:	515-252-7555
Fax Number	:	515-252-8848

Provider Business Practice Location Address
First Line	:	9379 SWANSON BLVD STE E
Second Line	:
City	:	CLIVE
State	:	IA
Zip	:	50325-6942
Country	:	US
Telephone Number	:	515-252-7555
Fax Number	:	515-252-8848

Authorized Official
Title or Position	:	PHARMACIST
Name	:	RICK PAULEY
Credential	:
Telephone Number	:	515-252-7555

Provider Enumeration Date	:	01/14/2010
Last Update Date	:	08/15/2016

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Directions to “FIVE STAR HEALTH SERVICES INC ” Practice Location

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