Provider Demographics
NPI:1114483559
Name:BRIGHTSTAR HEALTH CORP
Entity Type:Organization
Organization Name:BRIGHTSTAR HEALTH CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:OTENG
Authorized Official - Last Name:BOATENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-491-1090
Mailing Address - Street 1:5515 WALDOS BEACH RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-5505
Mailing Address - Country:US
Mailing Address - Phone:910-491-1090
Mailing Address - Fax:
Practice Address - Street 1:5515 WALDOS BEACH RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-5505
Practice Address - Country:US
Practice Address - Phone:910-491-1090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy