Healthcare Provider Details

I. General information

NPI: 1699967182
Provider Name (Legal Business Name): SHALONIE ROCHELLE SULLIVAN PHARMD, BCACP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHALONIE ROCHELLE MOORE PHARMD

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 PARK CREEK DR GOPC: PHARMACY DEPT
GREENVILLE SC
29605-4270
US

IV. Provider business mailing address

105 CHATIM RIDGE CT
LYMAN SC
29365-9005
US

V. Phone/Fax

Practice location:
  • Phone: 864-299-1600
  • Fax: 864-422-2614
Mailing address:
  • Phone: 864-517-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18433
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11661
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202207612
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number11661
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: