Healthcare Provider Details

I. General information

NPI: 1750290482
Provider Name (Legal Business Name): ERNST SUNEUS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1189 GRAPEVINE TRL
MONROE GA
30656-4515
US

IV. Provider business mailing address

1189 GRAPEVINE TRL
MONROE GA
30656-4515
US

V. Phone/Fax

Practice location:
  • Phone: 770-685-9435
  • Fax: 770-685-9435
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH025148
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: