Provider Demographics
NPI:1568895878
Name:STARK, JAMES COREY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:COREY
Last Name:STARK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 PARK AVE
Mailing Address - Street 2:RITE AID PHARMACY
Mailing Address - City:CARROLLTON
Mailing Address - State:KY
Mailing Address - Zip Code:41008-9513
Mailing Address - Country:US
Mailing Address - Phone:502-732-4392
Mailing Address - Fax:
Practice Address - Street 1:204 PARK AVE
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:CARROLLTON
Practice Address - State:KY
Practice Address - Zip Code:41008-9513
Practice Address - Country:US
Practice Address - Phone:502-732-4392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-11
Last Update Date:2013-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY016638183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY016638OtherKENTUCKY PHARMACIST LICENSE NUMBER