Healthcare Provider Details

I. General information

NPI: 1740418052
Provider Name (Legal Business Name): SULLIVAN UNIVERSITY SYSTEM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SULLIVAN UNIVERSITY WEST CAMPUS 2100 GARDINER LN
LOUISVILLE KY
40205-2962
US

IV. Provider business mailing address

SULLIVAN UNIVERSITY WEST CAMPUS 2100 GARDINER LN
LOUISVILLE KY
40205-2962
US

V. Phone/Fax

Practice location:
  • Phone: 502-413-8991
  • Fax: 502-413-8990
Mailing address:
  • Phone: 502-413-8991
  • Fax: 502-413-8990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07371
License Number StateKY

VIII. Authorized Official

Name: JULIE BURRIS
Title or Position: PIC
Credential:
Phone: 502-413-8979