Provider Demographics
NPI:1902197841
Name:TRI STAR MEDICAL PHARMACY LLC
Entity Type:Organization
Organization Name:TRI STAR MEDICAL PHARMACY LLC
Other - Org Name:TRI STAR MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-673-7829
Mailing Address - Street 1:2845 CAPITAL AVE SW
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-4185
Mailing Address - Country:US
Mailing Address - Phone:269-979-5402
Mailing Address - Fax:269-979-5609
Practice Address - Street 1:2845 CAPITAL AVE SW
Practice Address - Street 2:SUITE 301
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-4185
Practice Address - Country:US
Practice Address - Phone:269-979-5402
Practice Address - Fax:269-979-5609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010095653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2375536OtherNCPDP PROVIDER IDENTIFICATION NUMBER