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General NPI Number Information
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NPI Number | 1225243074
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Entity Type | Organization
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Legal Business Name | SUNSET NURSING SUPPLY
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 101 PROFESSIONAL AVE
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-4711
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Country | US
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Telephone | 803-794-6440
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Fax | 803-739-1420
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Provider Business Mailing Address
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Address Line | 101 PROFESSIONAL AVE
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-4711
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Country | US
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Telephone | 803-794-6440
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Fax | 803-739-1420
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Authorized Official
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Title or Position | OWNER
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Name | MR. WALTER GERALD ELLISOR
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Credential | RPH
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Telephone | 803-794-6440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number | 50002216
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License Number State | SC
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