Healthcare Provider Details

I. General information

NPI: 1487937298
Provider Name (Legal Business Name): AMY ELIZABETH SULLIVAN PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 JACKSON ST
LOWELL MA
01852-2103
US

IV. Provider business mailing address

161 JACKSON ST
LOWELL MA
01852-2103
US

V. Phone/Fax

Practice location:
  • Phone: 978-937-9700
  • Fax:
Mailing address:
  • Phone: 978-937-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPH27516
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number27516
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: