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General NPI Number Information
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NPI Number | 1679772065
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Entity Type | Individual
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Provider Name | JOSHUA WADE SULLIVAN PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 07/16/2007
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 116 N PAULINE ST
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City | MEMPHIS
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State | TN
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Zip | 38104-1005
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Country | US
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Telephone | 901-831-2905
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Fax |
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Provider Business Mailing Address
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Address Line | 40 DALTON CV
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City | EADS
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State | TN
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Zip | 38028-6250
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Country | US
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Telephone | 931-216-2362
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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 | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | 29432
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License Number State | TN
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