Provider Demographics
NPI:1376620088
Name:STARR, VICTORIA LOUISE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:LOUISE
Last Name:STARR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91320 COBURG INDUSTRIAL WAY BLDG 19
Mailing Address - Street 2:
Mailing Address - City:COBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97408-9492
Mailing Address - Country:US
Mailing Address - Phone:541-681-8117
Mailing Address - Fax:
Practice Address - Street 1:91320 COBURG INDUSTRIAL WAY BLDG 19
Practice Address - Street 2:
Practice Address - City:COBURG
Practice Address - State:OR
Practice Address - Zip Code:97408-9492
Practice Address - Country:US
Practice Address - Phone:541-681-8117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0010404183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR240449Medicaid