Provider Demographics
NPI:1407905433
Name:SULLIVAN, DANIEL J (RPH)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 GOFFSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-2746
Mailing Address - Country:US
Mailing Address - Phone:603-669-4771
Mailing Address - Fax:603-413-6410
Practice Address - Street 1:51 GOFFSTOWN RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-2746
Practice Address - Country:US
Practice Address - Phone:603-669-4771
Practice Address - Fax:603-413-6410
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR0758183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist