Healthcare Provider Details

I. General information

NPI: 1992010185
Provider Name (Legal Business Name): SUNSHINE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1536 W SUNSHINE ST
SPRINGFIELD MO
65807-2349
US

IV. Provider business mailing address

1536 W SUNSHINE ST
SPRINGFIELD MO
65807-2349
US

V. Phone/Fax

Practice location:
  • Phone: 417-863-0002
  • Fax: 417-863-0012
Mailing address:
  • Phone: 417-863-0002
  • Fax: 417-863-0012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2010032922
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2126134
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: NATALIE FOSTER
Title or Position: OWNER/PHARMACIST IN CHARGE
Credential:
Phone: 417-863-0002