Provider Demographics
NPI:1487632147
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:W
Authorized Official - Last Name:HERITAGE
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:256-534-1118
Mailing Address - Street 1:8020 HIGHWAY 72 W STE G
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-9567
Mailing Address - Country:US
Mailing Address - Phone:256-721-0739
Mailing Address - Fax:256-721-0778
Practice Address - Street 1:7950 HIGHWAY 72 W
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-6416
Practice Address - Country:US
Practice Address - Phone:256-721-0739
Practice Address - Fax:256-721-0778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL111666332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51530840OtherBCBS OF AL
AL009933203Medicaid