Provider Demographics
NPI:1801146212
Name:STAROSTA, ANN (PHARM D)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:STAROSTA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:BINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4175 VINEWOOD LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-2624
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4175 VINEWOOD LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55442-2624
Practice Address - Country:US
Practice Address - Phone:763-553-1757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121094183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist