Provider Demographics
NPI:1871634964
Name:SULLIVAN, MARY BARBARA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BARBARA
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 585
Mailing Address - Street 2:439 N.E.MAIN STREET
Mailing Address - City:DOUGLAS
Mailing Address - State:MA
Mailing Address - Zip Code:01516-0585
Mailing Address - Country:US
Mailing Address - Phone:508-476-7828
Mailing Address - Fax:
Practice Address - Street 1:MASSACHUSETTS COLLEGE OF PHARMACY AND HEALTH SCIENCES
Practice Address - Street 2:25 FOSTER STREET
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608
Practice Address - Country:US
Practice Address - Phone:508-373-0031
Practice Address - Fax:508-373-0032
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist