Provider Demographics
NPI:1598041758
Name:GOLD STAR PHARMACY LLC
Entity Type:Organization
Organization Name:GOLD STAR PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAIDELIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CADENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-579-1045
Mailing Address - Street 1:2895 SW 144TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7444
Mailing Address - Country:US
Mailing Address - Phone:407-579-1045
Mailing Address - Fax:
Practice Address - Street 1:2895 SW 144TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-7444
Practice Address - Country:US
Practice Address - Phone:407-579-1045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
APPLY333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy