Provider Demographics
NPI:1578893756
Name:SULLIVAN, LISA J (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:J
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 1:3204 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-2413
Mailing Address - Country:US
Mailing Address - Phone:512-869-0157
Mailing Address - Fax:512-863-6258
Practice Address - Street 1:3204 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-2413
Practice Address - Country:US
Practice Address - Phone:512-869-0157
Practice Address - Fax:512-863-6258
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS011926183500000X
TX52880183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist