Provider Demographics
NPI:1871845859
Name:SUNSHINE DRUG AND SUNDRY LLC
Entity Type:Organization
Organization Name:SUNSHINE DRUG AND SUNDRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER /PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:KUZEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:808-338-9907
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:9905 WAIMEA ROAD
Mailing Address - City:WAIMEA
Mailing Address - State:HI
Mailing Address - Zip Code:96796-0307
Mailing Address - Country:US
Mailing Address - Phone:808-338-9628
Mailing Address - Fax:808-338-9627
Practice Address - Street 1:9905 WAIMEA ROAD
Practice Address - Street 2:
Practice Address - City:WAIMEA
Practice Address - State:HI
Practice Address - Zip Code:96796
Practice Address - Country:US
Practice Address - Phone:808-338-9628
Practice Address - Fax:808-338-9627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPHY 8213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIPHY 821OtherPHARMACY LICENSE