Provider Demographics
NPI:1154867497
Name:STARBRIGHT LABS INC.
Entity Type:Organization
Organization Name:STARBRIGHT LABS INC.
Other - Org Name:986 PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:UNG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:323-749-6500
Mailing Address - Street 1:2670 E GAGE AVE STE 10A
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-7207
Mailing Address - Country:US
Mailing Address - Phone:323-749-6500
Mailing Address - Fax:323-749-6501
Practice Address - Street 1:2670 E GAGE AVE STE 10A
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-7207
Practice Address - Country:US
Practice Address - Phone:323-749-6500
Practice Address - Fax:323-749-6501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY554443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167241OtherPK
CA1154867497Medicaid