Provider Demographics
NPI:1629597612
Name:SULLIVAN, BARBARA NICOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:NICOLE
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 1:807 WOODSTONE DR APT E
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5572
Mailing Address - Country:US
Mailing Address - Phone:864-360-2811
Mailing Address - Fax:
Practice Address - Street 1:1080 ALICE DR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2463
Practice Address - Country:US
Practice Address - Phone:803-778-0460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37245183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist