Provider Demographics
NPI:1962505776
Name:HEALTHSTAR PHARMACY INC.
Entity type:Organization
Organization Name:HEALTHSTAR PHARMACY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:G
Authorized Official - Last Name:MARTRAGONO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-637-4700
Mailing Address - Street 1:5 WALKER ST
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:MA
Mailing Address - Zip Code:01240-2723
Mailing Address - Country:US
Mailing Address - Phone:413-637-4700
Mailing Address - Fax:413-637-4781
Practice Address - Street 1:5 WALKER ST
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:01240-2723
Practice Address - Country:US
Practice Address - Phone:413-637-4700
Practice Address - Fax:413-637-4781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3344332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPENDINGMedicaid
CT003125566Medicaid
DE0001079607Medicaid
NJ0050679Medicaid
NH30703172Medicaid
NY02586056Medicaid
VA010267421Medicaid
MA0404098Medicaid
VT1010874Medicaid
MD4058950 00Medicaid
AKPH143MAMedicaid
RIHP54396Medicaid
5274900001Medicare NSC