Provider Demographics
NPI:1265877518
Name:SULLIVAN, EMILY ELIZABETH (PHARMD, BCACP)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:ELIZABETH
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PHARMD, BCACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-5221
Mailing Address - Country:US
Mailing Address - Phone:218-205-7559
Mailing Address - Fax:
Practice Address - Street 1:1111 N ROOSEVELT DR
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:OR
Practice Address - Zip Code:97138-4607
Practice Address - Country:US
Practice Address - Phone:503-738-3002
Practice Address - Fax:503-738-3005
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60295014183500000X
ORRPH-00176101835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist