Provider Demographics
NPI:1063836195
Name:SUNSET PHARMACY DISCOUNT INC
Entity Type:Organization
Organization Name:SUNSET PHARMACY DISCOUNT INC
Other - Org Name:LA COLONIA PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YENIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ACEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:FMG
Authorized Official - Phone:786-803-8483
Mailing Address - Street 1:167 W 23RD ST STE D
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-2211
Mailing Address - Country:US
Mailing Address - Phone:305-608-1082
Mailing Address - Fax:786-360-2327
Practice Address - Street 1:7400 NW 19TH ST STE F
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-1217
Practice Address - Country:US
Practice Address - Phone:305-608-1082
Practice Address - Fax:786-360-2327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH275093336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144295OtherPK
7386410001Medicare NSC