=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154767663
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNSHINE PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2013
-----------------------------------------------------
Last Update Date | 05/13/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5480 RATTLESNAKE HAMMOCK RD
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34113-7454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-775-0600
-----------------------------------------------------
Fax | 239-775-3750
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5480 RATTLESNAKE HAMMOCK RD
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34113-7454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-775-6800
-----------------------------------------------------
Fax | 239-775-7377
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NEW OWNER
-----------------------------------------------------
Name | MR. ALDOFO REQUENA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 239-352-2033
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------