Provider Demographics
NPI:1598850232
Name:HOWARD STARK PROFESSIONAL PHARMACY
Entity Type:Organization
Organization Name:HOWARD STARK PROFESSIONAL PHARMACY
Other - Org Name:STARKS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUPP
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:913-345-3800
Mailing Address - Street 1:5701 W 119TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3721
Mailing Address - Country:US
Mailing Address - Phone:913-345-3800
Mailing Address - Fax:913-345-3803
Practice Address - Street 1:5701 W 119TH ST STE 125
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3721
Practice Address - Country:US
Practice Address - Phone:913-345-3800
Practice Address - Fax:913-345-3803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS82963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS10043276079Medicaid