Provider Demographics
NPI:1093168155
Name:SULKIN, PHILLIP J (RPH)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:J
Last Name:SULKIN
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 1:1236 WINDERMERE DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15218-1146
Mailing Address - Country:US
Mailing Address - Phone:412-855-7562
Mailing Address - Fax:
Practice Address - Street 1:1236 WINDERMERE DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15218-1146
Practice Address - Country:US
Practice Address - Phone:412-855-7562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP034291L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP034291LOtherRPH LICENCE