Provider Demographics
NPI:1255050258
Name:SULLIVAN, DELANIE AUTUMN (PHARM D)
Entity type:Individual
Prefix:
First Name:DELANIE
Middle Name:AUTUMN
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 1:673 HICKORY BLVD
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-3654
Mailing Address - Country:US
Mailing Address - Phone:931-212-5105
Mailing Address - Fax:
Practice Address - Street 1:231 NORTHGATE DR STE 100
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1436
Practice Address - Country:US
Practice Address - Phone:931-474-5050
Practice Address - Fax:931-474-5053
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36903183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist