Provider Demographics
NPI:1043473127
Name:SULLIVAN, HARRY M (RPH)
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:M
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 SHALLOWFORD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-6210
Mailing Address - Country:US
Mailing Address - Phone:423-855-8035
Mailing Address - Fax:423-893-3893
Practice Address - Street 1:5901 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-6210
Practice Address - Country:US
Practice Address - Phone:423-855-8035
Practice Address - Fax:423-893-3893
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist