Organization Name:  NORTH STAR INFUSION INC


Practice Location:
2301 HOUSE AVE SUITE 101 CHEYENNE, WY 82001 US
Tel: 307-637-7920  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
N	3336C0004X	Suppliers Pharmacy Compounding Pharmacy	WY
N	3336L0003X	Suppliers Pharmacy	WY
N	3336S0011X	Suppliers Pharmacy	WY
Y	3336C0003X	Suppliers Pharmacy	WY

Other Provider Identifiers:

Issuer	Number	State	Type
	125143100	WY	05

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin