Provider Demographics
NPI:1205258498
Name:SULLIVAN, JOAN E (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:E
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 261
Mailing Address - Street 2:
Mailing Address - City:VINEBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95487-0261
Mailing Address - Country:US
Mailing Address - Phone:707-939-1976
Mailing Address - Fax:
Practice Address - Street 1:7000 CARDINAL PL
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1091
Practice Address - Country:US
Practice Address - Phone:707-939-1976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-08
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1084183500000X
CA41986183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist