Provider Demographics
NPI:1720361280
Name:SULLIVAN, CHERYL GAIL (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:GAIL
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 WAVERLEY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5047
Mailing Address - Country:US
Mailing Address - Phone:978-681-1530
Mailing Address - Fax:978-681-1536
Practice Address - Street 1:800 WAVERLEY RD
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5047
Practice Address - Country:US
Practice Address - Phone:978-681-1530
Practice Address - Fax:978-681-1536
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16897183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist