Provider Demographics
NPI:1730755828
Name:STARCREST RX, LLC
Entity type:Organization
Organization Name:STARCREST RX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHIKEZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-310-3113
Mailing Address - Street 1:12151 JONES MALTSBERGER RD STE 113
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-4233
Mailing Address - Country:US
Mailing Address - Phone:210-310-3113
Mailing Address - Fax:210-310-3113
Practice Address - Street 1:12151 JONES MALTSBERGER RD STE 113
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-4233
Practice Address - Country:US
Practice Address - Phone:210-310-3113
Practice Address - Fax:210-310-3113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-31
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12345OtherNA