Healthcare Provider Details

I. General information

NPI: 1366756561
Provider Name (Legal Business Name): SUN HEALTH AND WELLNESS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E HINSON AVE
HAINES CITY FL
33844-5237
US

IV. Provider business mailing address

401 E HINSON AVE
HAINES CITY FL
33844-5237
US

V. Phone/Fax

Practice location:
  • Phone: 863-438-2799
  • Fax: 863-438-2770
Mailing address:
  • Phone: 863-438-2799
  • Fax: 863-438-2770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH24750
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BALA KODE
Title or Position: PRESIDENT
Credential: PHARM.D
Phone: 863-438-2799