Provider Demographics
NPI:1497020242
Name:JANE STAR CORPORATION
Entity Type:Organization
Organization Name:JANE STAR CORPORATION
Other - Org Name:STAR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHEIF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KYONG IL
Authorized Official - Middle Name:
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-224-8877
Mailing Address - Street 1:1400 ANDERSON AVE
Mailing Address - Street 2:UNIT 7
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-4405
Mailing Address - Country:US
Mailing Address - Phone:201-224-8877
Mailing Address - Fax:201-224-8871
Practice Address - Street 1:1400 ANDERSON AVE
Practice Address - Street 2:UNIT 7
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-4405
Practice Address - Country:US
Practice Address - Phone:201-224-8877
Practice Address - Fax:201-224-8871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS007180003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3198555OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NJ6723380001Medicare NSC