Provider Demographics
NPI:1023392602
Name:SULLIVAN, ANDREA RENEE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:RENEE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:RENEE
Other - Last Name:SPOONER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2105 20TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35223-1001
Mailing Address - Country:US
Mailing Address - Phone:256-655-6509
Mailing Address - Fax:
Practice Address - Street 1:2101 RICHARD ARRINGTON JR BLVD S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-1256
Practice Address - Country:US
Practice Address - Phone:205-969-1417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16768183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist