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General NPI Number Information
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NPI Number | 1659780518
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Entity Type | Organization
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Legal Business Name | SUNRISE PHARMACY LLC
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Dates
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Enumeration Date | 08/05/2014
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 4000 N STATE ROAD 7 SUITE 103
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33319-4804
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Country | US
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Telephone | 954-530-7171
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Fax | 954-440-4180
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Provider Business Mailing Address
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Address Line | 4000 N STATE ROAD 7 SUITE 103
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33319-4804
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Country | US
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Telephone | 954-530-7171
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Fax | 954-440-4180
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | DR. OLUWOLE AYOTUNDE OLUMIDE
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Credential | PHARMD
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Telephone | 954-530-7171
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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 | PH28385
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License Number State | FL
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