| NPI | 1720647027 |
|---|---|
| Doing Business As | SOUTHERN STAR PHARMACY 003 |
| Entity Type | Organization |
| Authorized Contact | TREY AUSTIN Managing Member 469-702-2006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2021-10-01 |