Provider Demographics
NPI:1902190028
Name:SULLIVAN, KRISTA MAES (RPH)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:MAES
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 1:7400 S GARTRELL RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-4236
Mailing Address - Country:US
Mailing Address - Phone:303-209-2828
Mailing Address - Fax:
Practice Address - Street 1:7400 S GARTRELL RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-4236
Practice Address - Country:US
Practice Address - Phone:303-209-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16987183500000X
IL051039567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist