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General NPI Number Information
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NPI Number | 1215064050
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Entity Type | Individual
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Provider Name | THOMAS EDWARD SULLIVAN R.PH.
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Gender | Male
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1010 S. PONCE DELEON BLVD WINN-DIXIE PHARMACY
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City | ST AUGUSTINE
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State | FL
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Zip | 32084
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Country | US
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Telephone | 904-825-2181
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Fax | 904-829-3643
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Provider Business Mailing Address
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Address Line | 1563 BARRINGTON CIR
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-3619
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Country | US
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Telephone | 904-940-1680
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS25069
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | NC 8523
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | MA 15211
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License Number State | MA
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