Healthcare Provider Details

I. General information

NPI: 1689825556
Provider Name (Legal Business Name): KAREEMA DENISE SULLIVAN PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 HOSPITAL DR
TOCCOA GA
30577-6820
US

IV. Provider business mailing address

3903 ATLANTA HWY
MONTGOMERY AL
36109-2918
US

V. Phone/Fax

Practice location:
  • Phone: 706-282-4268
  • Fax:
Mailing address:
  • Phone: 334-277-8253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number000784
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: