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1699967182 NPI number — SHALONIE ROCHELLE SULLIVAN PHARMD, BCACP

NPI Number: 1699967182
Health Care Provider/Practitioner: SHALONIE ROCHELLE SULLIVAN PHARMD, BCACP

Information about “1699967182” NPI (SHALONIE ROCHELLE SULLIVAN PHARMD, BCACP) exists in 1699967182 in HTML format HTML  |  1699967182 in plain Text format TXT  |  1699967182 in PDF (Portable Document Format) PDF  |  1699967182 in an XML format XML  formats.

NPI Number : 1699967182 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1699967182",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SULLIVAN",
    "FirstName": "SHALONIE",
    "MiddleName": "ROCHELLE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PHARMD, BCACP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MOORE",
    "OtherFirstName": "SHALONIE",
    "OtherMiddleName": "ROCHELLE",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "PHARMD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "105 CHATIM RIDGE CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LYMAN",
    "MailingAddressStateName": "SC",
    "MailingAddressPostalCode": "29365-9005",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "864-517-5252",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "41 PARK CREEK DR",
    "SecondLinePracticeLocationAddress": "GOPC: PHARMACY DEPT",
    "PracticeLocationAddressCityName": "GREENVILLE",
    "PracticeLocationAddressStateName": "SC",
    "PracticeLocationAddressPostalCode": "29605-4270",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "864-299-1600",
    "PracticeLocationAddressFaxNumber": "864-422-2614",
    "EnumerationDate": "08/17/2007",
    "LastUpdateDate": "07/01/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "18433",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "11661",
          "LicenseNumberStateCode": "SC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "0202207612",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1835P2201X",
          "TaxonomyName": "Ambulatory Care Pharmacist",
          "LicenseNumber": "11661",
          "LicenseNumberStateCode": "SC",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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