MEDICARE: BRIGHTSTAR HEALTH CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	3336C0003X	Community/Retail Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336S0011X	Specialty Pharmacy
4	183500000X	Pharmacist

General Provider Information

NPI Number	:	1710488333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTSTAR HEALTH CORP

Provider Business Mailing Address
First Line	:	5515 WALDOS BEACH RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28306-5505
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5515 WALDOS BEACH RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28306-5505
Country	:	US
Telephone Number	:	910-491-1090
Fax Number	:	910-425-5050

Authorized Official
Title or Position	:	OWNER/PHARMACIST
Name	:	MR. DEREK OTENG BOATENG
Credential	:
Telephone Number	:	910-491-1090

Provider Enumeration Date	:	02/28/2018
Last Update Date	:	11/20/2019

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Directions to “BRIGHTSTAR HEALTH CORP ” Practice Location

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