Healthcare Provider Details

I. General information

NPI: 1205446341
Provider Name (Legal Business Name): SUNNY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5364 JONESBORO RD
LAKE CITY GA
30260-3557
US

IV. Provider business mailing address

5364 JONESBORO RD
LAKE CITY GA
30260-3557
US

V. Phone/Fax

Practice location:
  • Phone: 770-676-7860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LEON VUONG
Title or Position: OWNER
Credential:
Phone: 678-973-0924