Provider Demographics
NPI:1154621704
Name:SULLIVAN, KATHRYN HARRIET (RPH)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:HARRIET
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2890 NORTH POWERS
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922
Mailing Address - Country:US
Mailing Address - Phone:719-573-4759
Mailing Address - Fax:719-573-1066
Practice Address - Street 1:2890 N POWERS BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-2800
Practice Address - Country:US
Practice Address - Phone:719-573-4759
Practice Address - Fax:719-573-1066
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist