Organization
SUN PHARMA LLC
Active
Other names
Galaxy Specialty Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
GANGADHAR REVULURI (OWNER / PIC)
(910) 574-3002
Entity
Organization
Contact information
Practice address
2829 BABCOCK RD STE 120, SAN ANTONIO, TX 78229-6009
(210) 617-4311
(210) 617-4312
Mailing address
2829 BABCOCK RD STE 120, SAN ANTONIO, TX 78229-6009
(210) 617-4311
(210) 617-4312
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
29858
TX
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2149470
PK
—
Enumeration date
03/25/2015
Last updated
07/21/2023
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