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Organization
STAR FORMULA INC
Active
Organization
STAR FORMULA INC
Active
Other names
Star Medical Specialties
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER J MITCHELL (OWNER)
(972) 380-2065
Entity
Organization
Contact information
Practice address
421 W MAGNOLIA AVE, FORT WORTH, TX 76104-7618
(817) 920-0509
(817) 920-1886
Mailing address
4386 SUNBELT DR, ADDISON, TX 75001-5611
(800) 365-2065
(800) 301-9488
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
NULL
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
NULL
Other
Enumeration date
10/23/2018
Last updated
01/20/2021
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