Provider Demographics
NPI:1174514145
Name:SULLIVAN, DONALD LAWRENCE (RPH, PHD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:LAWRENCE
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:RPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 MEADOWLARK LN
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-8495
Mailing Address - Country:US
Mailing Address - Phone:937-644-2970
Mailing Address - Fax:419-772-1917
Practice Address - Street 1:OHIO NORTHERN UNIVERSITY
Practice Address - Street 2:COLLEGE OF PHARMACY
Practice Address - City:ADA
Practice Address - State:OH
Practice Address - Zip Code:45810
Practice Address - Country:US
Practice Address - Phone:419-772-2309
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-18337183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist