Provider Demographics
NPI:1104873637
Name:SULLIVAN'S PHARMACY, LTD.
Entity type:Organization
Organization Name:SULLIVAN'S PHARMACY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PHARMACY TECH/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:CPT
Authorized Official - Phone:225-654-3901
Mailing Address - Street 1:4651 HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-3525
Mailing Address - Country:US
Mailing Address - Phone:225-654-3901
Mailing Address - Fax:225-654-3685
Practice Address - Street 1:4651 HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-3525
Practice Address - Country:US
Practice Address - Phone:225-654-3901
Practice Address - Fax:225-654-3685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA1911-IR333600000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1255572Medicaid
LA1255572Medicaid