Provider Demographics
NPI:1194855908
Name:FIVE STAR RX INC
Entity Type:Organization
Organization Name:FIVE STAR RX INC
Other - Org Name:FIVE STAR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:V
Authorized Official - Last Name:SADOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-786-0227
Mailing Address - Street 1:16438 VANOWEN ST
Mailing Address - Street 2:UNIT 101
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4733
Mailing Address - Country:US
Mailing Address - Phone:818-786-0227
Mailing Address - Fax:818-786-0312
Practice Address - Street 1:16438 VANOWEN ST
Practice Address - Street 2:UNIT 101
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-4733
Practice Address - Country:US
Practice Address - Phone:818-786-0227
Practice Address - Fax:818-786-0312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 49145333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0578887OtherNABP
CAPHY 49145OtherPHARMACY PERMIT
CA1194855908OtherMEDI-CAL PROVIDER NUMBER
CAFF1134763OtherDEA
CA6465900001Medicare NSC