Provider Demographics
NPI:1891416368
Name:SUNNY, JUBY ANNA (RPH)
Entity Type:Individual
Prefix:
First Name:JUBY
Middle Name:ANNA
Last Name:SUNNY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 BROADWAY MALL
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-2719
Mailing Address - Country:US
Mailing Address - Phone:516-806-2097
Mailing Address - Fax:
Practice Address - Street 1:2003 BROADWAY MALL
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-2719
Practice Address - Country:US
Practice Address - Phone:516-806-2097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist