Provider Demographics
NPI:1750372470
Name:STARRY, MARYSTAR JEAN (RPH, CDE)
Entity type:Individual
Prefix:MRS
First Name:MARYSTAR
Middle Name:JEAN
Last Name:STARRY
Suffix:
Gender:F
Credentials:RPH, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 LAKE MANOR RD NE
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:IA
Mailing Address - Zip Code:52333-8707
Mailing Address - Country:US
Mailing Address - Phone:319-841-8039
Mailing Address - Fax:
Practice Address - Street 1:701 10TH STREET SE
Practice Address - Street 2:MERCY MEDICAL CENTER KATZ CARDIOVASCULAR CENTER
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402
Practice Address - Country:US
Practice Address - Phone:319-398-6711
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist