Provider Demographics
NPI:1265978100
Name:SULLIVAN, ALICIA MICHELLE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:MICHELLE
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 1:200 COLUMBUS CORNERS DR
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-4905
Mailing Address - Country:US
Mailing Address - Phone:910-640-1189
Mailing Address - Fax:910-640-2958
Practice Address - Street 1:200 COLUMBUS CORNERS DR
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-4905
Practice Address - Country:US
Practice Address - Phone:910-640-1189
Practice Address - Fax:910-640-2958
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17263183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist