Provider Demographics
NPI:1730564733
Name:SUNSHINE PHARMACY SERVICES LLC
Entity type:Organization
Organization Name:SUNSHINE PHARMACY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCHUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-399-7701
Mailing Address - Street 1:634 PINE RIDGE DR STE B
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29172-1885
Mailing Address - Country:US
Mailing Address - Phone:803-939-8489
Mailing Address - Fax:803-399-7702
Practice Address - Street 1:1856 S LAKE DR STE K
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-7225
Practice Address - Country:US
Practice Address - Phone:803-399-7701
Practice Address - Fax:803-399-7702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC160793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151773OtherPK
SC716079Medicaid