Provider Demographics
NPI:1528498227
Name:SUNSHINE PHARMACY, INC.
Entity type:Organization
Organization Name:SUNSHINE PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:BROWN
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:828-669-0090
Mailing Address - Street 1:206 E STATE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-3541
Mailing Address - Country:US
Mailing Address - Phone:828-669-0090
Mailing Address - Fax:828-669-0094
Practice Address - Street 1:206 E STATE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-3541
Practice Address - Country:US
Practice Address - Phone:828-669-0090
Practice Address - Fax:828-669-0094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0116842Medicaid