Provider Demographics
NPI:1093316929
Name:SULLIVAN, SEAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 FULFORD CIR
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715-6911
Mailing Address - Country:US
Mailing Address - Phone:479-426-6709
Mailing Address - Fax:
Practice Address - Street 1:5000 W PAULINE WHITAKER PKWY
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-9104
Practice Address - Country:US
Practice Address - Phone:479-254-6806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD15336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist