MEDICARE: DR. ASHLEY SULLIVAN PHARM. D.

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	15455	OK

General Provider Information

NPI Number	:	1366884181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHLEY SULLIVAN PHARM. D.

Provider Business Mailing Address
First Line	:	9010 N 121ST EAST AVE
Second Line	:
City	:	OWASSO
State	:	OK
Zip	:	74055-5358
Country	:	US
Telephone Number	:	918-401-8001
Fax Number	:	918-401-1950

Provider Business Practice Location Address
First Line	:	9010 N 121ST EAST AVE
Second Line	:
City	:	OWASSO
State	:	OK
Zip	:	74055-5358
Country	:	US
Telephone Number	:	918-401-8001
Fax Number	:	918-401-1950

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

Provider Enumeration Date	:	07/22/2013
Last Update Date	:	06/29/2016

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