Healthcare Provider Details

I. General information

NPI: 1427153626
Provider Name (Legal Business Name): SULLIVAN'S PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CORINTH ST
ROSLINDALE MA
02131-3014
US

IV. Provider business mailing address

1 CORINTH ST
ROSLINDALE MA
02131-3014
US

V. Phone/Fax

Practice location:
  • Phone: 617-323-6544
  • Fax: 617-469-5627
Mailing address:
  • Phone: 617-323-6544
  • Fax: 617-469-5627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1243
License Number StateMA

VIII. Authorized Official

Name: LISA ROGERS
Title or Position: MANAGER
Credential: RPH
Phone: 617-323-6544