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NPI Code Detail

MEDICARE: MRS. ANDREA RENEE SULLIVAN PHARMD

MEDICARE: MRS. ANDREA RENEE SULLIVAN PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist16768AL

General Provider Information

NPI Number : 1023392602
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANDREA RENEE SULLIVAN PHARMD
Provider Business Mailing Address
First Line : 2105 20TH AVE S
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35223-1001
Country : US
Telephone Number : 256-655-6509
Fax Number :
Provider Business Practice Location Address
First Line : 2101 RICHARD ARRINGTON JR BLVD S
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35209-1256
Country : US
Telephone Number : 205-969-1417
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2011
Last Update Date : 09/30/2011

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