Provider Demographics
NPI:1093979304
Name:SUN, EDMOND S (RPH)
Entity Type:Individual
Prefix:
First Name:EDMOND
Middle Name:S
Last Name:SUN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20217
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14602-0217
Mailing Address - Country:US
Mailing Address - Phone:585-787-1190
Mailing Address - Fax:
Practice Address - Street 1:196 LANNING RD
Practice Address - Street 2:
Practice Address - City:HONEOYE FALLS
Practice Address - State:NY
Practice Address - Zip Code:14472-9711
Practice Address - Country:US
Practice Address - Phone:585-787-1190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038981183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist