Provider Demographics
NPI:1841650595
Name:VALUSTAR PHARMACY LLC
Entity type:Organization
Organization Name:VALUSTAR PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHAITANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GADDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-246-9104
Mailing Address - Street 1:7501 FANNIN ST STE 900
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1938
Mailing Address - Country:US
Mailing Address - Phone:877-246-9104
Mailing Address - Fax:888-963-8103
Practice Address - Street 1:7501 FANNIN ST STE 900
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1938
Practice Address - Country:US
Practice Address - Phone:877-246-9104
Practice Address - Fax:888-963-8103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-23
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X, 3336H0001X
TX302233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149611Medicaid
2162409OtherPK