Provider Demographics
NPI:1285620765
Name:SUN PHARMA INC
Entity type:Organization
Organization Name:SUN PHARMA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER / PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:POORNACHANDRA
Authorized Official - Middle Name:RAO
Authorized Official - Last Name:MALEPATI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-893-2400
Mailing Address - Street 1:1790 RANDALL AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-3629
Mailing Address - Country:US
Mailing Address - Phone:718-893-2400
Mailing Address - Fax:718-893-3281
Practice Address - Street 1:1790 RANDALL AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-3629
Practice Address - Country:US
Practice Address - Phone:718-893-2400
Practice Address - Fax:718-893-3281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0282993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02834673Medicaid
NY02834673Medicaid