Provider Demographics
NPI:1437235397
Name:STAR PHARMACY, INC.
Entity Type:Organization
Organization Name:STAR PHARMACY, INC.
Other - Org Name:STAR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ORLAND
Authorized Official - Middle Name:O
Authorized Official - Last Name:AMUNDSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:417-741-6266
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:HARTVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65667-0069
Mailing Address - Country:US
Mailing Address - Phone:417-741-6266
Mailing Address - Fax:417-741-1616
Practice Address - Street 1:118 EAST ROLLA ST
Practice Address - Street 2:
Practice Address - City:HARTVILLE
Practice Address - State:MO
Practice Address - Zip Code:65667-0069
Practice Address - Country:US
Practice Address - Phone:417-741-6266
Practice Address - Fax:417-741-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042865183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO601584006Medicaid