Provider Demographics
NPI:1396070561
Name:STAR PHARMA INC.
Entity type:Organization
Organization Name:STAR PHARMA INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RAMAKRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARAVAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-466-1790
Mailing Address - Street 1:115 FEATHERBED LN
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-1615
Mailing Address - Country:US
Mailing Address - Phone:718-466-1790
Mailing Address - Fax:718-466-1790
Practice Address - Street 1:115 FEATHERBED LN
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-1615
Practice Address - Country:US
Practice Address - Phone:718-466-1790
Practice Address - Fax:718-466-1790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0297383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3363265OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY02510561Medicaid
NY02510561Medicaid