Organization
STAR FORMULA INC
Active
Other names
STAR MEDICAL SPECAILTIES
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER J MITCHELL (CEO)
(972) 380-2065
Entity
Organization
Contact information
Practice address
5244 2ND ST NW, ALBUQUERQUE, NM 87107-4010
(800) 368-2065
(800) 301-9488
Mailing address
4386 SUNBELT DR, ADDISON, TX 75001-5611
(972) 380-2065
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
335G00000X
Medical Foods Supplier
—
—
Other
Enumeration date
06/26/2023
Last updated
07/06/2023
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