Healthcare Provider Details

I. General information

NPI: 1619202751
Provider Name (Legal Business Name): SUNRISE RX INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 SILLS RD BLDG 8B
EAST PATCHOGUE NY
11772-8800
US

IV. Provider business mailing address

285 SILLS RD BLDG 8B
EAST PATCHOGUE NY
11772-4869
US

V. Phone/Fax

Practice location:
  • Phone: 631-569-4245
  • Fax: 631-677-3500
Mailing address:
  • Phone: 631-569-4245
  • Fax: 631-677-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number029690
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RICHARD COLLINS
Title or Position: PRESIDENT
Credential:
Phone: 631-569-4245