Provider Demographics
NPI:1396920716
Name:SONNENBURG ENTERPRISES INC.
Entity type:Organization
Organization Name:SONNENBURG ENTERPRISES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SONNENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:979-836-3687
Mailing Address - Street 1:207 E ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-3207
Mailing Address - Country:US
Mailing Address - Phone:979-836-3687
Mailing Address - Fax:979-836-5741
Practice Address - Street 1:207 E ACADEMY ST
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-3207
Practice Address - Country:US
Practice Address - Phone:979-836-3687
Practice Address - Fax:979-836-5741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140835Medicaid
TX0885190001OtherMEDICARE PART B NSC#
TX4509848OtherNABP
TX0885190001Medicare NSC