Provider Demographics
NPI:1447339049
Name:SUNRISE PHARMACY INC
Entity type:Organization
Organization Name:SUNRISE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:HARRISON
Authorized Official - Last Name:ROHRBAUGH
Authorized Official - Suffix:II
Authorized Official - Credentials:RPH
Authorized Official - Phone:304-822-8312
Mailing Address - Street 1:HC 63 BOX 3550
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-9722
Mailing Address - Country:US
Mailing Address - Phone:304-822-8312
Mailing Address - Fax:304-822-8655
Practice Address - Street 1:ROUTE 50 EAST
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757
Practice Address - Country:US
Practice Address - Phone:304-822-8312
Practice Address - Fax:304-822-8655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSP05522873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV8500107000Medicaid
WV8500107000Medicaid