Provider Demographics
NPI:1154616860
Name:REDMAN-SULLIVAN, MELODY ANNE (PHARM D)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:ANNE
Last Name:REDMAN-SULLIVAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 S JAMES CAMPBELL BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-5193
Mailing Address - Country:US
Mailing Address - Phone:931-388-9004
Mailing Address - Fax:931-840-5742
Practice Address - Street 1:1202 S JAMES CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-5193
Practice Address - Country:US
Practice Address - Phone:931-388-9004
Practice Address - Fax:931-840-5742
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9738183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist