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NPI Code Detail

MEDICARE: SUN LIFE FAMILY HEALTH CENTER, INC.

MEDICARE: SUN LIFE FAMILY HEALTH CENTER, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0002XClinic PharmacyY006439AZ

General Provider Information

NPI Number : 1104290022
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUN LIFE FAMILY HEALTH CENTER, INC.
Provider Business Mailing Address
First Line : PO BOX 10097
Second Line :
City : CASA GRANDE
State : AZ
Zip : 85130-0020
Country : US
Telephone Number : 520-836-3446
Fax Number : 520-836-8807
Provider Business Practice Location Address
First Line : 44572 W BOWLIN RD
Second Line :
City : MARICOPA
State : AZ
Zip : 85138-4558
Country : US
Telephone Number : 520-568-2245
Fax Number : 520-568-2316
Authorized Official
Title or Position : DIRECTOR OF PHARMACY/AO
Name : MATTHEW BARTSCH
Credential :
Telephone Number : 520-381-0383
Provider Enumeration Date : 11/16/2015
Last Update Date : 08/03/2017

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