Organization
SUNRISE MEDICAL PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIM BUNSE (OWNER)
(916) 782-3137
Entity
Organization
Contact information
Practice address
1000 SUNRISE AVE, STE 1A, ROSEVILLE, CA 95661-7005
(916) 782-3137
(916) 782-3111
Mailing address
6873 DOUGLAS BLVD, GRANITE BAY, CA 95746-6259
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
021562
CA
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0578166
OTHER ID NUMBER
—
05
—
PHA413920
—
CA
Enumeration date
04/18/2006
Last updated
07/19/2007
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