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General NPI Number Information
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NPI Number | 1164956421
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Entity Type | Individual
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Provider Name | STEPHEN JOHN SULLIVAN JR. PHARMD.
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Gender | Male
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Dates
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Enumeration Date | 04/13/2017
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 30 NIGHTINGALE ROAD
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City | EDWARDS AFB
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State | CA
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Zip | 93524-0001
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Country | US
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Telephone | 661-275-2769
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Fax |
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Provider Business Mailing Address
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Address Line | 30 NIGHTINGALE ROAD
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City | EDWARDS AFB
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State | CA
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Zip | 93524-0001
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Country | US
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Telephone | 661-275-2769
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | RP00008628
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License Number State | NM
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