Provider Demographics
NPI:1740268499
Name:STAR DISCOUNT PHARMACY INC
Entity type:Organization
Organization Name:STAR DISCOUNT PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARDEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERITAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-534-1118
Mailing Address - Street 1:12078 HIGHWAY 231 431 N
Mailing Address - Street 2:
Mailing Address - City:MERIDIANVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35759-1225
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12078 HIGHWAY 231 431 N
Practice Address - Street 2:
Practice Address - City:MERIDIANVILLE
Practice Address - State:AL
Practice Address - Zip Code:35759-1225
Practice Address - Country:US
Practice Address - Phone:256-829-0209
Practice Address - Fax:256-829-0992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
AL1121043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100003302Medicaid
0131209OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1308890002Medicare NSC