Healthcare Provider Details

I. General information

NPI: 1851925671
Provider Name (Legal Business Name): SUNRISE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2020
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 WELLNESS WAY #110
VALLEY SPRINGS CA
95252-9525
US

IV. Provider business mailing address

51 WELLNESS WAY # 110
VALLEY SPRINGS CA
95252-9736
US

V. Phone/Fax

Practice location:
  • Phone: 209-772-9088
  • Fax:
Mailing address:
  • Phone: 209-772-9088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KIM PHAM
Title or Position: CEO
Credential: PHARM D
Phone: 209-772-9088