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General NPI Number Information
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NPI Number | 1609955863
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Entity Type | Individual
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Provider Name | PENNY ANN SULLIVAN-GREEN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 07/08/2024
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Provider Practice Location Address
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Address Line | 508 E WALNUT ST
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City | PARIS
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State | AR
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Zip | 72855-4019
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Country | US
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Telephone | 479-963-6400
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Fax | 479-963-2103
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Provider Business Mailing Address
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Address Line | 129 N REVEILLE ST
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City | MAGAZINE
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State | AR
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Zip | 72943-8422
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Country | US
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Telephone | 817-991-2918
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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 | 33123
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License Number State | TX
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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 | PD16404
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License Number State | AR
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