Provider Demographics
NPI:1558902296
Name:RISING STAR MEDICALS LLC
Entity Type:Organization
Organization Name:RISING STAR MEDICALS LLC
Other - Org Name:MEDSAVE RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANDANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAVURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-620-7220
Mailing Address - Street 1:PO BOX 1488
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-1405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 E RILEY ST STE B
Practice Address - Street 2:
Practice Address - City:FREER
Practice Address - State:TX
Practice Address - Zip Code:78357-1830
Practice Address - Country:US
Practice Address - Phone:361-394-7002
Practice Address - Fax:361-394-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150125Medicaid