Healthcare Provider Details

I. General information

NPI: 1881189157
Provider Name (Legal Business Name): SUNSET APOTHECARY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 S SUNSET AVENUE, STE A2
LITTLEFIELD TX
79339-4899
US

IV. Provider business mailing address

1506 S SUNSET AVE STE A
LITTLEFIELD TX
79339-4813
US

V. Phone/Fax

Practice location:
  • Phone: 806-385-4491
  • Fax:
Mailing address:
  • Phone: 806-385-4491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number32135
License Number StateTX

VIII. Authorized Official

Name: MICAH G PRATT
Title or Position: OWNER/MANAGER
Credential: PHARMACIST
Phone: 806-385-4491