Provider Demographics
NPI:1902164049
Name:HOMESTAR PHARMACY MAIL ORDER
Entity Type:Organization
Organization Name:HOMESTAR PHARMACY MAIL ORDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BORGIONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-526-7650
Mailing Address - Street 1:77 S COMMERCE WAY STE 230
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-8891
Mailing Address - Country:US
Mailing Address - Phone:610-628-8900
Mailing Address - Fax:
Practice Address - Street 1:77 S COMMERCE WAY STE 230
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-8891
Practice Address - Country:US
Practice Address - Phone:610-628-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. LUKE'S HOMESTAR SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-26
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4820143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102194739-0008Medicaid
PA1021947390006Medicaid