=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003058587
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNSHINE PHARMACY AT GOLDEN GATE BLVD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2009
-----------------------------------------------------
Last Update Date | 09/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 80 WILSON BLVD S STE 7
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34117-9386
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-384-5092
-----------------------------------------------------
Fax | 239-687-1295
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 80 WILSON BLVD S STE 7
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34117-9386
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-384-5092
-----------------------------------------------------
Fax | 235-687-1295
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DEL PARRISH
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 239-775-6800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH23952
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------