Provider Demographics
NPI:1023709573
Name:SUN HEALTH AND WELLNESS, INC
Entity type:Organization
Organization Name:SUN HEALTH AND WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BALA
Authorized Official - Middle Name:
Authorized Official - Last Name:KODE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-547-9922
Mailing Address - Street 1:401 E HINSON AVE
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-5237
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1300 US HIGHWAY 27 N STE 2
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1950
Practice Address - Country:US
Practice Address - Phone:863-547-9996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUN HEALTH AND WELLNESS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH34555OtherBOARD OF PHARMACY