Provider Demographics
NPI:1710168364
Name:SULLIVAN, ALFRED D (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:D
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 1:14 SKYWAY SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-3873
Mailing Address - Country:US
Mailing Address - Phone:518-561-3355
Mailing Address - Fax:518-563-9126
Practice Address - Street 1:14 SKYWAY SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-3873
Practice Address - Country:US
Practice Address - Phone:518-561-3355
Practice Address - Fax:518-563-9126
Is Sole Proprietor?:No
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY26031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist