Healthcare Provider Details

I. General information

NPI: 1376800367
Provider Name (Legal Business Name): SUNRISE RX PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2336 CLEVELAND AVE
FORT MYERS FL
33901-3540
US

IV. Provider business mailing address

2336 CLEVELAND AVE
FORT MYERS FL
33901-3540
US

V. Phone/Fax

Practice location:
  • Phone: 239-288-7450
  • Fax: 239-288-7451
Mailing address:
  • Phone: 239-288-7450
  • Fax: 239-288-7451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH26151
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ELIER GONZALEZ MARTINEZ
Title or Position: PRESIDENT/ OWNER
Credential:
Phone: 239-288-7450