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NPI Code Detail

MEDICARE: MICHAEL JOHN SULLIVAN RPH

MEDICARE: MICHAEL JOHN SULLIVAN RPH
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
1183500000XPharmacistPH1786HI
2183500000XPharmacist27185CA
3183500000XPharmacist5929MT
4183500000XPharmacist05637NV

General Provider Information

NPI Number : 1366717167
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL JOHN SULLIVAN RPH
Provider Business Mailing Address
First Line : 73-5600 MAIAU ST
Second Line :
City : KAILUA KONA
State : HI
Zip : 96740-2630
Country : US
Telephone Number : 808-331-4808
Fax Number : 808-331-4861
Provider Business Practice Location Address
First Line : 73-5600 MAIAU ST
Second Line :
City : KAILUA KONA
State : HI
Zip : 96740-2630
Country : US
Telephone Number : 808-331-4808
Fax Number : 808-331-4861
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2012
Last Update Date : 03/13/2012

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Directions to “ MICHAEL JOHN SULLIVAN RPH” Practice Location

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