Provider Demographics
NPI:1639400070
Name:SUNRISE ENTERPRISES INC
Entity Type:Organization
Organization Name:SUNRISE ENTERPRISES INC
Other - Org Name:MOUNTAINVIEW PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:UKOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-272-9612
Mailing Address - Street 1:1275 POWERS FERRY RD SE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-9486
Mailing Address - Country:US
Mailing Address - Phone:770-272-9612
Mailing Address - Fax:770-272-9613
Practice Address - Street 1:1275 POWERS FERRY RD SE STE 170
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-9487
Practice Address - Country:US
Practice Address - Phone:770-272-9612
Practice Address - Fax:770-272-9613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-25
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0096463336C0003X
3336C0004X, 3336L0003X, 3336M0002X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA951416911AMedicaid
2123636OtherPK