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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 PharmacyY005307AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Y005307OTHERAZPHARMACY LICENSE

General Provider Information

NPI Number : 1609186386
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 : 520-466-7883
Fax Number : 520-466-3946
Provider Business Practice Location Address
First Line : 205 N STUART BLVD
Second Line :
City : ELOY
State : AZ
Zip : 85131-2507
Country : US
Telephone Number : 520-999-9188
Fax Number : 520-381-3237
Authorized Official
Title or Position : DIRECTOR OF PHARMACY/AO
Name : MATTHEW BERTSCH
Credential :
Telephone Number : 520-836-3446
Provider Enumeration Date : 10/15/2010
Last Update Date : 08/02/2024

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Directions to “SUN LIFE FAMILY HEALTH CENTER, INC ” Practice Location

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