Provider Demographics
NPI:1265447882
Name:THREE STAR BUSINESS ENTERPRISES INC
Entity Type:Organization
Organization Name:THREE STAR BUSINESS ENTERPRISES INC
Other - Org Name:EASTERN DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AZIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:NASIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-686-1136
Mailing Address - Street 1:163 ORVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21221-1309
Mailing Address - Country:US
Mailing Address - Phone:410-686-1136
Mailing Address - Fax:410-686-1211
Practice Address - Street 1:163 ORVILLE RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221-1309
Practice Address - Country:US
Practice Address - Phone:410-686-1136
Practice Address - Fax:410-686-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MDP041973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408160900Medicaid
2037992OtherPK
MD408160900Medicaid