Provider Demographics
NPI:1225571243
Name:STARCARE INC
Entity Type:Organization
Organization Name:STARCARE INC
Other - Org Name:EXPRESS CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHAKIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAMDAMOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-618-7525
Mailing Address - Street 1:15 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-5801
Mailing Address - Country:US
Mailing Address - Phone:718-618-7525
Mailing Address - Fax:718-618-7526
Practice Address - Street 1:15 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-5801
Practice Address - Country:US
Practice Address - Phone:718-618-7525
Practice Address - Fax:718-618-7526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-22
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04609445Medicaid