Provider Demographics
NPI:1790945640
Name:ST LUKES HOMESTAR SERVICES LLC
Entity Type:Organization
Organization Name:ST LUKES HOMESTAR SERVICES LLC
Other - Org Name:HOMESTAR PHARMACY -BETHLEHEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BORGIONI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:484-526-7650
Mailing Address - Street 1:801 OSTRUM ST
Mailing Address - Street 2:STE 101 A
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1000
Mailing Address - Country:US
Mailing Address - Phone:484-526-7500
Mailing Address - Fax:484-526-5199
Practice Address - Street 1:801 OSTRUM ST
Practice Address - Street 2:STE 101 A
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1000
Practice Address - Country:US
Practice Address - Phone:484-526-7500
Practice Address - Fax:484-526-5199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4816153336C0003X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021947390001Medicaid
2082578OtherPK