Healthcare Provider Details

I. General information

NPI: 1104873637
Provider Name (Legal Business Name): SULLIVAN'S PHARMACY, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4651 HIGHWAY 19
ZACHARY LA
70791-3525
US

IV. Provider business mailing address

4651 HIGHWAY 19
ZACHARY LA
70791-3525
US

V. Phone/Fax

Practice location:
  • Phone: 225-654-3901
  • Fax: 225-654-3685
Mailing address:
  • Phone: 225-654-3901
  • Fax: 225-654-3685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberLA1911-IR
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberLA1911-IR
License Number StateLA

VIII. Authorized Official

Name: TONYA MORRISON
Title or Position: CERTIFIED PHARMACY TECH/MANAGER
Credential: CPT
Phone: 225-654-3901