Healthcare Provider Details

I. General information

NPI: 1528678000
Provider Name (Legal Business Name): SUN LIFE FAMILY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2020
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 W AMERICAN AVE
ORACLE AZ
85623-6089
US

IV. Provider business mailing address

1040 W AMERICAN AVE
ORACLE AZ
85623-6089
US

V. Phone/Fax

Practice location:
  • Phone: 520-858-0006
  • Fax: 520-381-3237
Mailing address:
  • Phone: 520-858-0006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MATTHEW BERTSCH
Title or Position: DIRECTOR OF PHARMACY/AO
Credential:
Phone: 520-836-3446