Healthcare Provider Details

I. General information

NPI: 1487584645
Provider Name (Legal Business Name): KAITLYN SULLIVAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N 19TH AVE
BOZEMAN MT
59718-3758
US

IV. Provider business mailing address

533 E RIVER ROCK RD
BELGRADE MT
59714-7220
US

V. Phone/Fax

Practice location:
  • Phone: 406-586-3550
  • Fax:
Mailing address:
  • Phone: 406-586-3550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number117258
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: