Provider Demographics
NPI:1265428056
Name:SULLIVAN, EMMETT J (RPH)
Entity type:Individual
Prefix:MR
First Name:EMMETT
Middle Name:J
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-1843
Mailing Address - Country:US
Mailing Address - Phone:203-421-4543
Mailing Address - Fax:
Practice Address - Street 1:270 FARMINGTON AVE SUITE 108
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-5654
Practice Address - Country:US
Practice Address - Phone:860-679-4035
Practice Address - Fax:860-679-0303
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8022183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist