Provider Demographics
NPI:1336318468
Name:MEDSTAR INC
Entity Type:Organization
Organization Name:MEDSTAR INC
Other - Org Name:MEDSTAR INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HORTENSIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMADOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-362-5848
Mailing Address - Street 1:2108 W 68TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1804
Mailing Address - Country:US
Mailing Address - Phone:305-362-5848
Mailing Address - Fax:305-362-5847
Practice Address - Street 1:2108 W 68TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1804
Practice Address - Country:US
Practice Address - Phone:305-362-5848
Practice Address - Fax:305-362-5847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH231443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1032591OtherNCPDP PROVIDER IDENTIFICATION NUMBER
FL6088970001Medicare NSC