MEDICARE: SUN RX DRUGS 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
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PH00496	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2056442	OTHER		PK

General Provider Information

NPI Number	:	1306958301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUN RX DRUGS INC

Provider Business Mailing Address
First Line	:	2410 E BONANZA RD
Second Line	:	2410 E BONANZA RD
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-3452
Country	:	US
Telephone Number	:	702-382-1166
Fax Number	:	702-382-0651

Provider Business Practice Location Address
First Line	:	2410 E BONANZA RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-3452
Country	:	US
Telephone Number	:	702-382-1166
Fax Number	:	702-382-0651

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRIAN HOLT
Credential	:
Telephone Number	:	702-382-1166

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	02/15/2017

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Directions to “SUN RX DRUGS INC ” Practice Location

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