Provider Demographics
NPI:1023439429
Name:MASTERTON, SUNNY RAE (RPH)
Entity type:Individual
Prefix:MRS
First Name:SUNNY
Middle Name:RAE
Last Name:MASTERTON
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 1:4430 N HOLLAND SYLVANIA RD
Mailing Address - Street 2:APT 2302
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-2598
Mailing Address - Country:US
Mailing Address - Phone:419-787-4009
Mailing Address - Fax:
Practice Address - Street 1:217 E US HIGHWAY 223
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-4215
Practice Address - Country:US
Practice Address - Phone:517-266-2133
Practice Address - Fax:517-266-2165
Is Sole Proprietor?:No
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020346556183500000X
OH03325802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist