Provider Demographics
NPI:1740671866
Name:SUNLIFE PHARMACY
Entity type:Organization
Organization Name:SUNLIFE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:LEON
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:754-816-5158
Mailing Address - Street 1:7164 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-2627
Mailing Address - Country:US
Mailing Address - Phone:754-816-5158
Mailing Address - Fax:754-816-5159
Practice Address - Street 1:7164 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-2627
Practice Address - Country:US
Practice Address - Phone:754-816-5158
Practice Address - Fax:754-816-5159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH28882302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization