Provider Demographics
NPI:1902949738
Name:SUNNYSIDE PRESBYTERIAN HOME
Entity Type:Organization
Organization Name:SUNNYSIDE PRESBYTERIAN HOME
Other - Org Name:SUNNYSIDE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:540-568-8249
Mailing Address - Street 1:600 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE L
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3763
Mailing Address - Country:US
Mailing Address - Phone:540-568-8600
Mailing Address - Fax:540-568-8248
Practice Address - Street 1:3935 SUNNYSIDE DR
Practice Address - Street 2:SUITE A
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-2328
Practice Address - Country:US
Practice Address - Phone:540-568-8249
Practice Address - Fax:540-568-8645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010027533336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008530491Medicaid
2104987OtherPK