Provider Demographics
NPI:1760077754
Name:5 STAR PROFESSIONAL SERVICES, LLC
Entity Type:Organization
Organization Name:5 STAR PROFESSIONAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBS-BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, MBA
Authorized Official - Phone:678-373-9881
Mailing Address - Street 1:516 SOSEBEE FARM RD UNIT 1426
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-0154
Mailing Address - Country:US
Mailing Address - Phone:678-373-9881
Mailing Address - Fax:
Practice Address - Street 1:849 NATCHEZ VALLEY TRCE
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-4963
Practice Address - Country:US
Practice Address - Phone:678-373-9881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty