Provider Demographics
NPI:1871194878
Name:SULLIVAN, BRIANNA KATHERINE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:BRIANNA
Middle Name:KATHERINE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5433 REIDLAND RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-0954
Mailing Address - Country:US
Mailing Address - Phone:270-898-7313
Mailing Address - Fax:270-898-1999
Practice Address - Street 1:5433 REIDLAND RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-0954
Practice Address - Country:US
Practice Address - Phone:270-898-7313
Practice Address - Fax:270-898-1999
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY021293183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist