Provider Demographics
NPI:1679972780
Name:RISING SUN PHARMACY INC
Entity Type:Organization
Organization Name:RISING SUN PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BINDU
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:267-977-8259
Mailing Address - Street 1:9307 LARAMIE RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-2737
Mailing Address - Country:US
Mailing Address - Phone:267-977-8259
Mailing Address - Fax:215-613-7093
Practice Address - Street 1:500 DEVEREAUX AVE
Practice Address - Street 2:A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-5767
Practice Address - Country:US
Practice Address - Phone:215-613-6272
Practice Address - Fax:215-613-7093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4824583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy