Provider Demographics
NPI:1164714929
Name:SULLIVAN, LINDA S (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:S
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 E. SANTE FE ST.
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062
Mailing Address - Country:US
Mailing Address - Phone:913-782-2323
Mailing Address - Fax:913-764-2754
Practice Address - Street 1:2101 E. SANTE FE ST.
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062
Practice Address - Country:US
Practice Address - Phone:913-782-2323
Practice Address - Fax:913-764-2754
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-09309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist