Provider Demographics
NPI:1336127158
Name:STAR DISCOUNT PHARMACY INC
Entity Type:Organization
Organization Name:STAR DISCOUNT PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DARDEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:HERITAGE
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:256-534-1118
Mailing Address - Street 1:704 PRATT AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3644
Mailing Address - Country:US
Mailing Address - Phone:256-534-1118
Mailing Address - Fax:256-534-1121
Practice Address - Street 1:704 PRATT AVE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3644
Practice Address - Country:US
Practice Address - Phone:256-534-1118
Practice Address - Fax:256-534-1121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL111666332B00000X, 333600000X, 3336C0003X, 3336C0004X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009962810Medicaid
AL51097066OtherBCBS OF AL
AL51519615OtherBCBS OF AL
AL51519615OtherBCBS OF AL