Provider Demographics
NPI:1043756695
Name:SULLIVAN PHARMACY SERVICES INC.
Entity type:Organization
Organization Name:SULLIVAN PHARMACY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WISDOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-771-2091
Mailing Address - Street 1:6555 NW 9TH AVE
Mailing Address - Street 2:STE 208
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-2067
Mailing Address - Country:US
Mailing Address - Phone:954-771-2091
Mailing Address - Fax:
Practice Address - Street 1:6555 NW 9TH AVE
Practice Address - Street 2:STE 208
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-2067
Practice Address - Country:US
Practice Address - Phone:954-771-2091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy