Provider Demographics
NPI:1528190550
Name:SUN DRUG INC
Entity Type:Organization
Organization Name:SUN DRUG INC
Other - Org Name:SUN DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-860-6866
Mailing Address - Street 1:10810 E VIA LINDA
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-3909
Mailing Address - Country:US
Mailing Address - Phone:480-860-6866
Mailing Address - Fax:480-860-6051
Practice Address - Street 1:10810 E VIA LINDA
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-3909
Practice Address - Country:US
Practice Address - Phone:480-860-6866
Practice Address - Fax:480-860-6051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
AZY0018863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0315285OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0841810001Medicare NSC