Provider Demographics
NPI:1952308280
Name:SUNRISE MEDICATIONS INC
Entity Type:Organization
Organization Name:SUNRISE MEDICATIONS INC
Other - Org Name:MEDI HOME PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JEFFCOAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-957-0500
Mailing Address - Street 1:PO BOX 1928
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29071-1928
Mailing Address - Country:US
Mailing Address - Phone:803-957-0500
Mailing Address - Fax:888-342-6190
Practice Address - Street 1:2 PALMETTO WOOD PKWY
Practice Address - Street 2:STE 100
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2881
Practice Address - Country:US
Practice Address - Phone:877-936-1045
Practice Address - Fax:877-936-9735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15202333600000X, 333600000X
3336C0003X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC715202Medicaid
SCDE3161Medicaid
SC715202Medicaid
SCQ477540001Medicare PIN