=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104166222
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNSET PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2013
-----------------------------------------------------
Last Update Date | 02/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3101 SUNSET BLVD STE 4C
-----------------------------------------------------
City | ROCKLIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95677-3089
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-630-8783
-----------------------------------------------------
Fax | 916-630-8763
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3101 SUNSET BLVD STE 4C
-----------------------------------------------------
City | ROCKLIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95677-3089
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-630-8783
-----------------------------------------------------
Fax | 916-630-8763
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | TOM THANH NGUYEN
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 916-666-0977
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------