Provider Demographics
NPI:1083757462
Name:SUNRISE PHARMACY OF CAPON BRIDGE
Entity Type:Organization
Organization Name:SUNRISE PHARMACY OF CAPON BRIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBSBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:304-822-7257
Mailing Address - Street 1:HC 61 BOX 301
Mailing Address - Street 2:
Mailing Address - City:CAPON BRIDGE
Mailing Address - State:WV
Mailing Address - Zip Code:26711
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:SUITES 2 AND 3 BEAR GARDEN PLAZA
Practice Address - Street 2:
Practice Address - City:CAPON BRIDGE
Practice Address - State:WV
Practice Address - Zip Code:26711
Practice Address - Country:US
Practice Address - Phone:304-856-3301
Practice Address - Fax:304-856-3312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
WVSP05523513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5054452OtherOTHER ID NUMBER-COMMERCIAL NUMBER