Indian Star Pharm Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH25674 Issued in FL

Legal business name

INDIAN STAR PHARM INC.

Practice address

9500 NW 79 Av Bay4
Hialeah Gardens, FL 33016

Phone

(786) 506-6084

NPI assigned

Jun 22, 2011

Last updated

Dec 27, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mario Reyes

Title

President

Phone

(786) 506-6084

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324944000000",
    "number": "1366738916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9012 NW 145TH ST",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "33018",
            "telephone_number": "305-826-2170",
            "fax_number": "305-826-2162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 NW 79 AV BAY4",
            "city": "HIALEAH GARDENS",
            "state": "FL",
            "postal_code": "33016",
            "telephone_number": "786-506-6084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN STAR PHARM INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-22",
        "last_updated": "2011-12-27",
        "status": "A",
        "authorized_official_last_name": "REYES",
        "authorized_official_first_name": "MARIO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "786-506-6084"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH25674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Retail Pharmacy in Hialeah Gardens, FL
• Providers in Hialeah Gardens, FL by specialty
• Community/Retail Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.