Provider Demographics
NPI:1407129521
Name:SULLIVAN, PATRICK JOHN (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:JOHN
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 MAIN AVE N
Mailing Address - Street 2:
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141-7784
Mailing Address - Country:US
Mailing Address - Phone:503-815-1433
Mailing Address - Fax:503-815-1427
Practice Address - Street 1:2500 MAIN AVE N
Practice Address - Street 2:
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141-7784
Practice Address - Country:US
Practice Address - Phone:503-815-1433
Practice Address - Fax:503-815-1427
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0010196183500000X
OR00101961835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist