# STAR FORMULA INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Star Medical Specialties
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841766235
- **Authorized official:** JENNIFER J MITCHELL (OWNER)
- **Authorized official phone:** (972) 380-2065

## Contact information

- **Practice address:** 421 W MAGNOLIA AVE, FORT WORTH, TX 76104-7618
- **Practice address phone:** (817) 920-0509
- **Practice address fax:** (817) 920-1886
- **Mailing address:** 4386 SUNBELT DR, ADDISON, TX 75001-5611
- **Mailing address phone:** (800) 365-2065
- **Mailing address fax:** (800) 301-9488

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |
| 332BP3500X | Parenteral & Enteral Nutrition Supplies (DME) | — | NULL | — |

## Other

- **Enumeration date:** 10/23/2018
- **Last updated:** 01/20/2021