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General NPI Number Information
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NPI Number | 1821685835
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Entity Type | Individual
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Provider Name | CLARENCE FRANCIS SULLIVAN III PHARMD
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Gender | Male
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Dates
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Enumeration Date | 12/23/2020
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Last Update Date | 12/23/2020
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Provider Practice Location Address
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Address Line | 450 SOUTHLAND DR STE A
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City | LEXINGTON
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State | KY
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Zip | 40503-1831
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Country | US
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Telephone | 859-278-7282
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Fax |
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Provider Business Mailing Address
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Address Line | 450 SOUTHLAND DR STE A
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City | LEXINGTON
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State | KY
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Zip | 40503-1831
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Country | US
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Telephone | 859-278-7282
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Fax | 859-278-7299
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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 | KY008745
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License Number State | KY
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