Provider Demographics
NPI:1104944701
Name:STAR SERVICE PHARMACY INC
Entity type:Organization
Organization Name:STAR SERVICE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANISLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-552-1919
Mailing Address - Street 1:11629 SW 216TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-2908
Mailing Address - Country:US
Mailing Address - Phone:305-552-1919
Mailing Address - Fax:305-552-1980
Practice Address - Street 1:11629 SW 216TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33170-2908
Practice Address - Country:US
Practice Address - Phone:305-552-1919
Practice Address - Fax:305-552-1980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEIN
FL5920810002Medicare NSC