Provider Demographics
NPI:1770974859
Name:STAR ALLIANCE HEALTH GROUP INC
Entity type:Organization
Organization Name:STAR ALLIANCE HEALTH GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:ANKIT
Authorized Official - Middle Name:
Authorized Official - Last Name:BHALODIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-301-8868
Mailing Address - Street 1:27994 BRADLEY RD
Mailing Address - Street 2:#H
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92586-2240
Mailing Address - Country:US
Mailing Address - Phone:951-301-8868
Mailing Address - Fax:951-246-3083
Practice Address - Street 1:27994 BRADLEY RD
Practice Address - Street 2:#H
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92586-2240
Practice Address - Country:US
Practice Address - Phone:951-301-8868
Practice Address - Fax:951-246-3083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY520453336C0003X, 3336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5654074OtherNCPDP