Provider Demographics
NPI:1063760734
Name:GOLDEN SUNRISE PHARMACEUTICAL, INC.
Entity type:Organization
Organization Name:GOLDEN SUNRISE PHARMACEUTICAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HUU
Authorized Official - Middle Name:S
Authorized Official - Last Name:TIEU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-781-0658
Mailing Address - Street 1:560 W PUTNAM AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3269
Mailing Address - Country:US
Mailing Address - Phone:559-781-0658
Mailing Address - Fax:559-788-2946
Practice Address - Street 1:560 W PUTNAM AVE STE 2
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3269
Practice Address - Country:US
Practice Address - Phone:559-781-0658
Practice Address - Fax:559-788-2946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy