Healthcare Provider Details

I. General information

NPI: 1487759577
Provider Name (Legal Business Name): SULLIVAN'S HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 BELGRADE AVE.
ROSLINDALE MA
02131
US

IV. Provider business mailing address

30 BELGRADE AVE.
ROSLINDALE MA
02131-3087
US

V. Phone/Fax

Practice location:
  • Phone: 617-327-0210
  • Fax:
Mailing address:
  • Phone: 617-327-0210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number3335
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number3335
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number3335
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberDS3335
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number3335
License Number StateMA
# 6
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number3335
License Number StateMA

VIII. Authorized Official

Name: MR. SAM METHRATTA
Title or Position: PHARMACY DIRECTOR
Credential: PHARMD
Phone: 617-363-1726