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General NPI Number Information
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NPI Number | 1285989830
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Entity Type | Organization
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Legal Business Name | SUN PHARMACY INC
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Dates
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Enumeration Date | 07/19/2012
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 6350 BROOKLYN BLVD
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City | BROOKLYN CENTER
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State | MN
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Zip | 55429-2669
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Country | US
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Telephone | 763-561-0722
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Fax | 763-561-0723
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Provider Business Mailing Address
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Address Line | 6350 BROOKLYN BLVD
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City | BROOKLYN CENTER
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State | MN
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Zip | 55429
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Country | US
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Telephone | 763-561-0722
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Fax | 763-561-0723
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | PAO KUE
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Credential | PHARMD
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Telephone | 763-561-0722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 263920
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License Number State | MN
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