Provider Demographics
NPI:1740418052
Name:SULLIVAN UNIVERSITY SYSTEM INC
Entity Type:Organization
Organization Name:SULLIVAN UNIVERSITY SYSTEM INC
Other - Org Name:SULLIVAN UNIVERSITY COLLEGE OF PHARMACY -THE CENTER FOR HEAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-413-8979
Mailing Address - Street 1:SULLIVAN UNIVERSITY WEST CAMPUS
Mailing Address - Street 2:2100 GARDINER LN
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2962
Mailing Address - Country:US
Mailing Address - Phone:502-413-8991
Mailing Address - Fax:502-413-8990
Practice Address - Street 1:SULLIVAN UNIVERSITY WEST CAMPUS
Practice Address - Street 2:2100 GARDINER LN
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-2962
Practice Address - Country:US
Practice Address - Phone:502-413-8991
Practice Address - Fax:502-413-8990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP073713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2121507OtherPK