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General NPI Number Information
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NPI Number | 1639217623
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Entity Type | Organization
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Legal Business Name | SULLIVAN PHARMACEUTICALS INC
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 11/18/2011
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Provider Practice Location Address
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Address Line | 6123 LA SALLE AVE
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City | OAKLAND
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State | CA
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Zip | 94611-2801
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Country | US
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Telephone | 510-339-9393
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Fax | 510-339-9394
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Provider Business Mailing Address
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Address Line | 6123 LA SALLE AVE
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City | OAKLAND
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State | CA
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Zip | 94611-2801
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Country | US
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Telephone | 510-339-9393
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Fax | 510-339-9394
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | WILLIAM SULLIVAN
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Credential |
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Telephone | 510-339-9393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY38259
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License Number State | CA
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