Provider Demographics
NPI:1003975004
Name:STAR DRUGS INC
Entity Type:Organization
Organization Name:STAR DRUGS INC
Other - Org Name:STAR DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAYNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-649-0499
Mailing Address - Street 1:922 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-8402
Mailing Address - Country:US
Mailing Address - Phone:718-649-0499
Mailing Address - Fax:
Practice Address - Street 1:922 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-8402
Practice Address - Country:US
Practice Address - Phone:718-649-0499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0280853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2068683OtherPK
NY2852959Medicaid
5866550001Medicare NSC