Provider Demographics
NPI:1629470794
Name:SUNIL PHARMACY IV INC.
Entity Type:Organization
Organization Name:SUNIL PHARMACY IV INC.
Other - Org Name:11TH & WALNUT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SUBHASH
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:215-603-8288
Mailing Address - Street 1:1207 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19122-4301
Mailing Address - Country:US
Mailing Address - Phone:215-235-3245
Mailing Address - Fax:215-232-2859
Practice Address - Street 1:134 S 11TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4931
Practice Address - Country:US
Practice Address - Phone:215-238-0002
Practice Address - Fax:215-238-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-20
Last Update Date:2014-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4825093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy