Provider Demographics
NPI:1316499577
Name:SULLIVAN, CANDICE MARIE (PHARM D)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:MARIE
Last Name: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 1:122 DEER VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-9501
Mailing Address - Country:US
Mailing Address - Phone:412-716-8449
Mailing Address - Fax:
Practice Address - Street 1:535 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:PA
Practice Address - Zip Code:15202-3548
Practice Address - Country:US
Practice Address - Phone:412-761-1890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP451175183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist