Provider Demographics
NPI:1760564561
Name:PROSTAR PHARMACY CONSULTANTS LLC
Entity Type:Organization
Organization Name:PROSTAR PHARMACY CONSULTANTS LLC
Other - Org Name:MONACARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:STARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-681-8117
Mailing Address - Street 1:91320 COBURG INDUSTRIAL WAY
Mailing Address - Street 2:BLDG 19
Mailing Address - City:COBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97408
Mailing Address - Country:US
Mailing Address - Phone:541-681-8117
Mailing Address - Fax:541-681-8164
Practice Address - Street 1:91320 COBURG INDUSTRIAL WAY
Practice Address - Street 2:BLDG 19
Practice Address - City:COBURG
Practice Address - State:OR
Practice Address - Zip Code:97408
Practice Address - Country:US
Practice Address - Phone:541-681-8117
Practice Address - Fax:541-681-8164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRP0002261CS3336M0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3842184OtherOTHER ID NUMBER-COMMERCIAL NUMBER