1194349431 NPI number — SOUTHERN STAR PHARMACY 002

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194349431 NPI number — SOUTHERN STAR PHARMACY 002

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN STAR PHARMACY 002
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194349431
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2698 N GALLOWAY AVE STE 108
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESQUITE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75150-6390
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-646-6057
Provider Business Mailing Address Fax Number:
877-743-4398

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2698 N GALLOWAY AVE STE 108
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESQUITE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75150-6390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-646-6057
Provider Business Practice Location Address Fax Number:
877-743-4398
Provider Enumeration Date:
06/02/2020

Additional Information

Authorized Official

Authorized Official Last Name:
AHMED
Authorized Official First Name:
SYEDA
Authorized Official Middle Name:
SAIMA
Authorized Official Title or Position:
DIRECTOR OF PHARMACY
Authorized Official Telephone Number:
972-677-7891

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 33256 . This is a "TX BOP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 5931503 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".




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