Provider Demographics
NPI:1225243074
Name:SUNSET NURSING SUPPLY
Entity Type:Organization
Organization Name:SUNSET NURSING SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:ELLISOR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:803-794-6440
Mailing Address - Street 1:101 PROFESSIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-4711
Mailing Address - Country:US
Mailing Address - Phone:803-794-6440
Mailing Address - Fax:803-739-1420
Practice Address - Street 1:101 PROFESSIONAL AVE
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4711
Practice Address - Country:US
Practice Address - Phone:803-794-6440
Practice Address - Fax:803-739-1420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC500022163336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4215578OtherNABP