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General NPI Number Information
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NPI Number | 1366042145
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Entity Type | Individual
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Provider Name | TOM SULLIVAN
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Gender | Male
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Dates
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Enumeration Date | 10/29/2020
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Last Update Date | 10/29/2020
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Provider Practice Location Address
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Address Line | 2400 W PASEWALK AVE
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City | NORFOLK
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State | NE
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Zip | 68701-4608
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Country | US
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Telephone | 402-371-6232
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Fax | 402-371-9485
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Provider Business Mailing Address
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Address Line | 3302 MACH 1 DR
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City | NORFOLK
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State | NE
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Zip | 68701-3098
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Country | US
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Telephone | 402-649-1821
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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 | 11642
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License Number State | NE
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