Provider Demographics
NPI:1285934687
Name:SULLIVAN, TAMMY K (RPH)
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:K
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 1:14020 E SPRAGUE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-2125
Mailing Address - Country:US
Mailing Address - Phone:509-891-6319
Mailing Address - Fax:509-891-7330
Practice Address - Street 1:14020 E SPRAGUE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-2125
Practice Address - Country:US
Practice Address - Phone:509-891-6319
Practice Address - Fax:509-891-7330
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00019751183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist