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General NPI Number Information
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NPI Number | 1821476169
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Entity Type | Individual
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Provider Name | MICHELLE SULLIVAN
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Gender | Female
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Dates
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Enumeration Date | 05/06/2015
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 1150 EASTMAN RD
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City | CENTER CONWAY
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State | NH
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Zip | 03813-4221
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Country | US
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Telephone | 603-356-5471
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Fax |
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Provider Business Mailing Address
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Address Line | 25 HARRIS ST APT 6
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City | ACTON
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State | MA
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Zip | 01720-4111
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Country | US
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Telephone | 978-856-5090
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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 | R2412
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License Number State | NH
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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 | PH233288
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License Number State | MA
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