Provider Demographics
NPI:1992877112
Name:BRIGHT STAR PHARMACY
Entity type:Organization
Organization Name:BRIGHT STAR PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIDIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-390-5364
Mailing Address - Street 1:2350 W 84TH ST STE 7
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5574
Mailing Address - Country:US
Mailing Address - Phone:786-235-0696
Mailing Address - Fax:786-235-0695
Practice Address - Street 1:2350 W 84TH ST STE 7
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5574
Practice Address - Country:US
Practice Address - Phone:786-235-0696
Practice Address - Fax:786-235-0695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH199463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy