MEDICARE: MS. MAUREEN FRANCES 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
1	183500000X	Pharmacist	PS22558	FL
2	183500000X	Pharmacist	RPH03210	RI

General Provider Information

NPI Number	:	1750664728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAUREEN FRANCES SULLIVAN RPH

Provider Business Mailing Address
First Line	:	12750 S NORMANDY WAY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33410-1422
Country	:	US
Telephone Number	:	561-624-1861
Fax Number	:

Provider Business Practice Location Address
First Line	:	4530 LANTANA RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-6908
Country	:	US
Telephone Number	:	561-963-2588
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2011
Last Update Date	:	09/26/2011

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