Provider Demographics
NPI:1942772272
Name:RISING STAR HOLDINGS LLC
Entity Type:Organization
Organization Name:RISING STAR HOLDINGS LLC
Other - Org Name:SAN DIEGO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NANDANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAVURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-620-7220
Mailing Address - Street 1:PO BOX 1488
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-1488
Mailing Address - Country:US
Mailing Address - Phone:361-209-8322
Mailing Address - Fax:361-209-5022
Practice Address - Street 1:508 E GRAVIS ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:TX
Practice Address - Zip Code:78384-2708
Practice Address - Country:US
Practice Address - Phone:361-209-8322
Practice Address - Fax:361-209-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-27
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy