Healthcare Provider Details

I. General information

NPI: 1851540546
Provider Name (Legal Business Name): KATHERINE MARIE SULLIVAN PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 METROHEALTH DR PHARMACY SERVICES
CLEVELAND OH
44109-1900
US

IV. Provider business mailing address

2500 METROHEALTH DR PHARMACY SERVICES
CLEVELAND OH
44109-1900
US

V. Phone/Fax

Practice location:
  • Phone: 216-778-1946
  • Fax: 216-778-1003
Mailing address:
  • Phone: 216-778-1946
  • Fax: 216-778-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03-2-28165
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: