Provider Demographics
NPI:1225043839
Name:HOWARD STARK PHARMACY INC
Entity Type:Organization
Organization Name:HOWARD STARK PHARMACY INC
Other - Org Name:STARK PROFESSIONAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ERNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUPP
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:816-363-3232
Mailing Address - Street 1:6420 PROSPECT AVE
Mailing Address - Street 2:T103
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-4147
Mailing Address - Country:US
Mailing Address - Phone:816-363-3232
Mailing Address - Fax:816-361-6402
Practice Address - Street 1:6420 PROSPECT AVE STE T103
Practice Address - Street 2:T103
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-4175
Practice Address - Country:US
Practice Address - Phone:816-363-3232
Practice Address - Fax:816-361-6402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2011-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
MO20010304913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2634295OtherNCPDP PROVIDER IDENTIFICATION NUMBER