Healthcare Provider Details

I. General information

NPI: 1336508308
Provider Name (Legal Business Name): SUN PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2559 S KING RD SUITE B10
SAN JOSE CA
95122-1894
US

IV. Provider business mailing address

2559 S KING RD SUITE B10
SAN JOSE CA
95122-1894
US

V. Phone/Fax

Practice location:
  • Phone: 408-440-2077
  • Fax: 408-677-3957
Mailing address:
  • Phone: 408-440-2077
  • Fax: 408-677-3957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number54368
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number54368
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY54368
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LUU PHUONG NGUYEN
Title or Position: OWNER, PIC, AO
Credential: RPH
Phone: 408-440-2077