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General NPI Number Information
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NPI Number | 1144435645
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Entity Type | Organization
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Legal Business Name | PHARM-MED CORPORATION
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 01/22/2019
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Provider Practice Location Address
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Address Line | 450 SOUTHLAND DR STE A
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City | LEXINGTON
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State | KY
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Zip | 40503-1831
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Country | US
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Telephone | 859-278-7282
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Fax | 859-278-7299
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Provider Business Mailing Address
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Address Line | 450 SOUTHLAND DR STE A
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City | LEXINGTON
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State | KY
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Zip | 40503-1831
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Country | US
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Telephone | 859-278-7282
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Fax | 859-278-7299
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Authorized Official
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Title or Position | DOCTOR OF PHARMACY
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Name | DR. CLARENCE F SULLIVAN III
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Credential | PHARMD
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Telephone | 859-421-0639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | KY08745
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License Number State | KY
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