Provider Demographics
NPI:1881189157
Name:SUNSET APOTHECARY, LLC
Entity Type:Organization
Organization Name:SUNSET APOTHECARY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:G
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:806-385-4491
Mailing Address - Street 1:1506 S SUNSET AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LITTLEFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:79339-4813
Mailing Address - Country:US
Mailing Address - Phone:806-385-4491
Mailing Address - Fax:
Practice Address - Street 1:1506 S SUNSET AVENUE, STE A2
Practice Address - Street 2:
Practice Address - City:LITTLEFIELD
Practice Address - State:TX
Practice Address - Zip Code:79339-4899
Practice Address - Country:US
Practice Address - Phone:806-385-4491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX321353336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy