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NPI Code Detail

MEDICARE: THOMAS S. SULLIVAN M.S., R.PH., BCNSP

MEDICARE: THOMAS S. SULLIVAN M.S., R.PH., BCNSP
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
1183500000XPharmacist5302025761MI
21835N1003XNutrition Support Pharmacist5302025761MI

General Provider Information

NPI Number : 1477547933
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS S. SULLIVAN M.S., R.PH., BCNSP
Provider Business Mailing Address
First Line : 324 BELANGER ST
Second Line :
City : GROSSE POINTE FARMS
State : MI
Zip : 48236-3302
Country : US
Telephone Number : 313-378-5416
Fax Number :
Provider Business Practice Location Address
First Line : 21230 DEQUINDRE RD
Second Line :
City : WARREN
State : MI
Zip : 48091-2279
Country : US
Telephone Number : 586-880-2483
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2005
Last Update Date : 04/07/2022

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