Healthcare Provider Details

I. General information

NPI: 1336805597
Provider Name (Legal Business Name): CASSANDRA SULLIVAN PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CASSANDRA WISYANSKI

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 01/31/2025
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 WILLIAM PN HWY
MONROEVILLE PA
15146
US

IV. Provider business mailing address

4931 PLUM WAY
PITTSBURGH PA
15201
US

V. Phone/Fax

Practice location:
  • Phone: 412-372-5288
  • Fax: 412-374-9089
Mailing address:
  • Phone: 724-289-6657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP459098
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: