MEDICARE: SUN PHARMACY, 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	3336C0004X	Compounding Pharmacy
2	333600000X	Pharmacy
3	332B00000X	Durable Medical Equipment & Medical Supplies	54368	CA
4	332BX2000X	Oxygen Equipment & Supplies (DME)	54368	CA
5	3336C0003X	Community/Retail Pharmacy	PHY54368	CA

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	2158484	OTHER		PK

General Provider Information

NPI Number	:	1336508308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUN PHARMACY, INC.

Provider Business Mailing Address
First Line	:	2559 S KING RD
Second Line	:	SUITE B10
City	:	SAN JOSE
State	:	CA
Zip	:	95122-1894
Country	:	US
Telephone Number	:	408-440-2077
Fax Number	:	408-677-3957

Provider Business Practice Location Address
First Line	:	2559 S KING RD
Second Line	:	SUITE B10
City	:	SAN JOSE
State	:	CA
Zip	:	95122-1894
Country	:	US
Telephone Number	:	408-440-2077
Fax Number	:	408-677-3957

Authorized Official
Title or Position	:	OWNER, PIC, AO
Name	:	LUU PHUONG NGUYEN
Credential	:	RPH
Telephone Number	:	408-440-2077

Provider Enumeration Date	:	02/18/2016
Last Update Date	:	04/19/2017

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Directions to “SUN PHARMACY, INC. ” Practice Location

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