Provider Demographics
NPI:1174646137
Name:SULLIVANT, JENNIFER J (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:J
Last Name:SULLIVANT
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 1:1505 SULLIVANT RD
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-7239
Mailing Address - Country:US
Mailing Address - Phone:662-578-2999
Mailing Address - Fax:
Practice Address - Street 1:440 HIGHWAY 6 E
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-3000
Practice Address - Country:US
Practice Address - Phone:662-855-1204
Practice Address - Fax:662-855-1218
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-8654183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist