Provider Demographics
NPI:1487112405
Name:SUNRAY CHESTER LLC
Entity type:Organization
Organization Name:SUNRAY CHESTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-729-2000
Mailing Address - Street 1:5518 CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-5328
Mailing Address - Country:US
Mailing Address - Phone:215-729-2000
Mailing Address - Fax:215-729-2400
Practice Address - Street 1:5518 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-5328
Practice Address - Country:US
Practice Address - Phone:215-729-2000
Practice Address - Fax:215-729-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPP482856OtherSTATE PHARMACY LICENSE