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General NPI Number Information
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NPI Number | 1588913701
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Entity Type | Organization
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Legal Business Name | SUNRISE PHARMACY
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Dates
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Enumeration Date | 09/04/2012
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Last Update Date | 09/04/2012
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Provider Practice Location Address
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Address Line | 1235 INDIAN TRAIL RD, SUITE 200A
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City | NORCROSS
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State | GA
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Zip | 30093
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Country | US
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Telephone | 239-246-4314
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Fax |
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Provider Business Mailing Address
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Address Line | 1235 INDIAN TRAIL RD, SUITE 200A
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City | NORCROSS
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State | GA
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Zip | 30093
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACIST/MANAGER
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Name | VIMAL BAROT
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Credential | RPH
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Telephone | 239-246-4314
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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 | PHRE009866
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License Number State | GA
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