Provider Demographics
NPI:1437170875
Name:SUNRAY DRUGS LLC
Entity Type:Organization
Organization Name:SUNRAY DRUGS LLC
Other - Org Name:SUNRAY DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:TANCREDI
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARM
Authorized Official - Phone:215-474-4615
Mailing Address - Street 1:142 S 52ND STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139
Mailing Address - Country:US
Mailing Address - Phone:215-474-4615
Mailing Address - Fax:215-476-9821
Practice Address - Street 1:142 S 52ND STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139
Practice Address - Country:US
Practice Address - Phone:215-474-4615
Practice Address - Fax:215-476-9821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412499L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018860270001Medicaid
PAPP412499LOtherPA BOARD OF PHARMACY
PAPP412499LOtherPA BOARD OF PHARMACY
PABS9439577OtherDEA