Provider Demographics
NPI:1588966162
Name:SULLIVAN, ALINE BONNO (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALINE
Middle Name:BONNO
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 COPPERPLATE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-6437
Mailing Address - Country:US
Mailing Address - Phone:803-237-8571
Mailing Address - Fax:
Practice Address - Street 1:1523 COPPERPLATE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-6437
Practice Address - Country:US
Practice Address - Phone:803-237-8571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17940183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist