MEDICARE: GARRY SULLIVAN

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	28650	FL

General Provider Information

NPI Number	:	1538763404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARRY SULLIVAN

Provider Business Mailing Address
First Line	:	2781 COTTONWOOD CT
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33761-3809
Country	:	US
Telephone Number	:	727-743-1968
Fax Number	:

Provider Business Practice Location Address
First Line	:	467 MANDALAY AVE
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33767-2013
Country	:	US
Telephone Number	:	727-447-6429
Fax Number	:

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

Provider Enumeration Date	:	11/23/2020
Last Update Date	:	11/23/2020

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Directions to “ GARRY SULLIVAN ” Practice Location

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