Provider Demographics
NPI:1750664728
Name:SULLIVAN, MAUREEN FRANCES (RPH)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:FRANCES
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 1:12750 S NORMANDY WAY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-1422
Mailing Address - Country:US
Mailing Address - Phone:561-624-1861
Mailing Address - Fax:
Practice Address - Street 1:4530 LANTANA RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-6908
Practice Address - Country:US
Practice Address - Phone:561-963-2588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22558183500000X
RIRPH03210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist