=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760967160
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JONATHAN SUN PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2018
-----------------------------------------------------
Last Update Date | 01/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2868 ACTON RD
-----------------------------------------------------
City | VESTAVIA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35243-2502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-941-8880
-----------------------------------------------------
Fax | 855-583-3156
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2868 ACTON RD
-----------------------------------------------------
City | VESTAVIA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35243-2502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-524-6181
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 17448
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------