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SUNNYSIDE DRUG

Company Details

Name: SUNNYSIDE DRUG
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 15 Mar 2017 (8 years ago)
Entity Number: 582246
Place of Formation: IDAHO
File Number: 0000582246
ZIP code: 83849
County: Shoshone County
Mailing Address: PO BOX 2170 OSBURN, ID 83849

National Provider Identifier

NPI Number:
1871748012

Authorized Person:

Name:
RON LAVIGNE
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
332B00000X - Durable Medical Equipment & Medical Supplies
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Initial Filing 0000582246 2017-03-15

Date of last update: 26 Sep 2024

Sources: Idaho Secretary of State