Healthcare Provider Details

I. General information

NPI: 1245659622
Provider Name (Legal Business Name): SUNNY KHEIREDDINE PHARMD, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 04/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LONGWOOD AVE
ROCKLEDGE FL
32955-2828
US

IV. Provider business mailing address

110 LONGWOOD AVE
ROCKLEDGE FL
32955-2828
US

V. Phone/Fax

Practice location:
  • Phone: 321-637-2102
  • Fax: 321-690-6717
Mailing address:
  • Phone: 321-637-2102
  • Fax: 321-690-6717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS51401
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23317
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: