Provider Demographics
NPI:1164745444
Name:ST LUKES HOMESTAR SERVICES LLC
Entity Type:Organization
Organization Name:ST LUKES HOMESTAR SERVICES LLC
Other - Org Name:ST. LUKE'S HOMESTAR PHARMACY - ALLENTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BORGIONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-526-7650
Mailing Address - Street 1:1736 HAMILTON ST
Mailing Address - Street 2:1ST FLOOR - SOUTH TOWER
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-5656
Mailing Address - Country:US
Mailing Address - Phone:610-628-7577
Mailing Address - Fax:610-628-7579
Practice Address - Street 1:1736 HAMILTON ST
Practice Address - Street 2:1ST FLOOR - SOUTH TOWER
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5656
Practice Address - Country:US
Practice Address - Phone:610-628-7577
Practice Address - Fax:610-628-7579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
PAPP4820143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2124004OtherPK
PA1021947390006Medicaid