Healthcare Provider Details

I. General information

NPI: 1265428056
Provider Name (Legal Business Name): EMMETT J SULLIVAN R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 FARMINGTON AVE SUITE 108
FARMINGTON CT
06030-5654
US

IV. Provider business mailing address

352 GREEN HILL RD
MADISON CT
06443-2354
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-4035
  • Fax: 860-679-0303
Mailing address:
  • Phone: 203-215-0526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8022
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: