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General NPI Number Information
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NPI Number | 1811550098
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Entity Type | Individual
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Provider Name | ERIC SULLIVAN PHARM.D
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Gender | Male
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Dates
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Enumeration Date | 04/15/2019
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Last Update Date | 04/15/2019
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Provider Practice Location Address
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Address Line | 4425 VENETUCCI BLVD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-4013
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Country | US
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Telephone | 719-313-4385
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Fax | 719-313-4379
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Provider Business Mailing Address
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Address Line | 4425 VENETUCCI BLVD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-4013
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Country | US
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Telephone | 719-313-4385
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Fax | 719-313-4379
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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 | 03237022
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License Number State | OH
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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 | PHA.0020928
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License Number State | CO
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