Provider Demographics
NPI:1225030323
Name:SULLIVAN, BEVERLY A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:A
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 MOUNTAIN SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-5387
Mailing Address - Country:US
Mailing Address - Phone:307-766-2550
Mailing Address - Fax:307-766-2953
Practice Address - Street 1:1000 E. UNIVERSITY AVE
Practice Address - Street 2:DEPT. 3375
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82071-3375
Practice Address - Country:US
Practice Address - Phone:307-766-2550
Practice Address - Fax:307-766-2953
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist