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General NPI Number Information
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NPI Number | 1003920158
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Entity Type | Organization
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Legal Business Name | SUN DRUG INC
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2730 STILLWATER RD
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City | MAPLEWOOD
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State | MN
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Zip | 55119
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Country | US
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Telephone | 651-735-2300
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Fax | 651-735-2301
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Provider Business Mailing Address
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Address Line | 2730 STILLWATER RD
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City | MAPLEWOOD
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State | MN
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Zip | 55119
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Country | US
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Telephone | 651-735-2300
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Fax | 651-735-2301
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Authorized Official
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Title or Position | PHARMACIST OWNER
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Name | MR. SALAH A FATTAH
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Credential | RPH
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Telephone | 651-735-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 2599250
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License Number State | MN
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