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General NPI Number Information
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NPI Number | 1982021366
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Entity Type | Individual
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Provider Name | MELISSA SULLIVAN PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 03/24/2014
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Last Update Date | 11/07/2014
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Provider Practice Location Address
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Address Line | 12810 S TRYON ST
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City | CHARLOTTE
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State | NC
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Zip | 28273-6949
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Country | US
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Telephone | 704-587-0513
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Fax | 704-900-0625
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Provider Business Mailing Address
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Address Line | 12810 S TRYON ST
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City | CHARLOTTE
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State | NC
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Zip | 28273-6949
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Country | US
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Telephone | 704-587-0513
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Fax | 704-900-0625
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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 | 14097
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License Number State | SC
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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 | 21902
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 27084
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License Number State | GA
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