Provider Demographics
NPI:1194348797
Name:STARFISH PHARMACY LLC
Entity type:Organization
Organization Name:STARFISH PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUBSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-524-4380
Mailing Address - Street 1:3100 SHORE DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1199
Mailing Address - Country:US
Mailing Address - Phone:757-524-4380
Mailing Address - Fax:888-851-0736
Practice Address - Street 1:3100 SHORE DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-1199
Practice Address - Country:US
Practice Address - Phone:757-524-4380
Practice Address - Fax:888-851-0736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-19
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1194348797Medicaid