Organization
STAR FORMULA INC
Active
Other names
Star Medical Specialties
Organization subpart
No
Provider details
NPI number
Authorized official
GREG L JACKSON AO (OWNER)
(800) 368-2065
Entity
Organization
Contact information
Practice address
428 E JEFFERSON BLVD STE 123, DALLAS, TX 75203-5613
(214) 942-2862
(915) 942-2920
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
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
—
—
Other
Enumeration date
10/24/2018
Last updated
10/24/2018
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