Provider Demographics
NPI:1538275417
Name:SUNCARE MEDICAL, INC.
Entity type:Organization
Organization Name:SUNCARE MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-724-0999
Mailing Address - Street 1:7880 FOUNDATION DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-3047
Mailing Address - Country:US
Mailing Address - Phone:866-891-9765
Mailing Address - Fax:
Practice Address - Street 1:7880 FOUNDATION DR
Practice Address - Street 2:SUITE 2
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-3047
Practice Address - Country:US
Practice Address - Phone:866-891-9765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP06761333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4041180003Medicare ID - Type UnspecifiedPHARMACY