MEDICARE: STAR REX PHARMACY LLC

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	3336C0003X	Community/Retail Pharmacy	26919	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2119649	OTHER		PK

General Provider Information

NPI Number	:	1689810517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAR REX PHARMACY LLC

Provider Business Mailing Address
First Line	:	9701 N SAM HOUSTON PKWY E
Second Line	:	SUITE 110
City	:	HUMBLE
State	:	TX
Zip	:	77396-4636
Country	:	US
Telephone Number	:	281-973-8042
Fax Number	:	281-973-8525

Provider Business Practice Location Address
First Line	:	11110 EAST FWY
Second Line	:	100B
City	:	HOUSTON
State	:	TX
Zip	:	77029-1914
Country	:	US
Telephone Number	:	832-767-0816
Fax Number	:	832-767-0819

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	BRENTLEY GENTRY
Credential	:	B.S.
Telephone Number	:	281-973-8042

Provider Enumeration Date	:	12/23/2008
Last Update Date	:	12/01/2016

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Directions to “STAR REX PHARMACY LLC ” Practice Location

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