Provider Demographics
NPI:1902165160
Name:SUNSHINE PHARMACY LLC
Entity type:Organization
Organization Name:SUNSHINE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIDANE
Authorized Official - Middle Name:
Authorized Official - Last Name:ASSEFA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:340-774-1531
Mailing Address - Street 1:9151 EST.THOMAS
Mailing Address - Street 2:FOOTHILLS PROF BLDG 107/108
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802
Mailing Address - Country:US
Mailing Address - Phone:340-774-1551
Mailing Address - Fax:340-774-1517
Practice Address - Street 1:9151 ESTATE THOMAS
Practice Address - Street 2:FOOTHILLS PROF BLDG 107/108
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-2617
Practice Address - Country:US
Practice Address - Phone:340-774-1551
Practice Address - Fax:340-774-1517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X
VI114771L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5300518OtherNCPDP PROVIDER IDENTIFICATION NUMBER