Provider Demographics
NPI:1437535093
Name:SULLIVAN, CHRISTOPHER (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:
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 1:214 S VAN L MUNGO BLVD
Mailing Address - Street 2:
Mailing Address - City:PAGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29728-1950
Mailing Address - Country:US
Mailing Address - Phone:843-675-2323
Mailing Address - Fax:843-675-2025
Practice Address - Street 1:214 S VAN L MUNGO BLVD
Practice Address - Street 2:
Practice Address - City:PAGELAND
Practice Address - State:SC
Practice Address - Zip Code:29728-1950
Practice Address - Country:US
Practice Address - Phone:843-675-2323
Practice Address - Fax:843-675-2025
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36278183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist