Provider Demographics
NPI:1619314606
Name:FOUR STAR RX INC
Entity Type:Organization
Organization Name:FOUR STAR RX INC
Other - Org Name:ANS COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DIPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:732-421-6533
Mailing Address - Street 1:1835 N BROADWAY AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-2040
Mailing Address - Country:US
Mailing Address - Phone:732-421-6533
Mailing Address - Fax:
Practice Address - Street 1:1835 N BROADWAY AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-2040
Practice Address - Country:US
Practice Address - Phone:732-421-6533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540182073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy