Provider Demographics
NPI:1730318577
Name:MEDSTAR PHARMACY INC
Entity type:Organization
Organization Name:MEDSTAR PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUYNH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-472-2737
Mailing Address - Street 1:200 N CARRIER PKWY STE 112
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-5476
Mailing Address - Country:US
Mailing Address - Phone:214-677-1460
Mailing Address - Fax:214-677-1461
Practice Address - Street 1:200 N CARRIER PKWY STE 112
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-5476
Practice Address - Country:US
Practice Address - Phone:214-677-1460
Practice Address - Fax:214-677-1461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy