Provider Demographics
NPI:1649484726
Name:SULLIVAN, JOHN F (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:F
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 1:44 TIMBER LN
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-4644
Mailing Address - Country:US
Mailing Address - Phone:978-685-1923
Mailing Address - Fax:
Practice Address - Street 1:44 TIMBER LN
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-4644
Practice Address - Country:US
Practice Address - Phone:978-685-1923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15022183500000X
NH1744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA15022OtherPHARMACY REGISTRATION #
NH1744OtherNH REGISTRATION #