MEDICARE: MS. LAURA E SULLIVAN PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	1-13741	KS
2	183500000X	Pharmacist	045304	MO

General Provider Information

NPI Number	:	1083809818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA E SULLIVAN PHARMD

Provider Business Mailing Address
First Line	:	3303 GRAND OAKS CT
Second Line	:
City	:	PITTSBURG
State	:	KS
Zip	:	66762-8737
Country	:	US
Telephone Number	:	620-231-0843
Fax Number	:

Provider Business Practice Location Address
First Line	:	3303 GRAND OAKS CT
Second Line	:
City	:	PITTSBURG
State	:	KS
Zip	:	66762-8737
Country	:	US
Telephone Number	:	620-231-0843
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2007
Last Update Date	:	09/14/2007

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