1003058587 NPI number — SUNSHINE PHARMACY AT GOLDEN GATE BLVD INC

Table of content: (NPI 1003058587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003058587 NPI number — SUNSHINE PHARMACY AT GOLDEN GATE BLVD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNSHINE PHARMACY AT GOLDEN GATE BLVD INC
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:
SUNSHINE AT GOLDEN GATE
Provider Other Organization Name Type Code:
3
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:
1003058587
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
80 WILSON BLVD S
Provider Second Line Business Mailing Address:
STE 7
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34117-9386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-384-5092
Provider Business Mailing Address Fax Number:
235-687-1295

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 WILSON BLVD S
Provider Second Line Business Practice Location Address:
STE 7
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34117-9386
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-384-5092
Provider Business Practice Location Address Fax Number:
239-687-1295
Provider Enumeration Date:
03/31/2009

Additional Information

Authorized Official

Authorized Official Last Name:
PARRISH
Authorized Official First Name:
DEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
239-775-6800

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PH23952 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1043859 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com