Provider Demographics
NPI:1699967182
Name:SULLIVAN, SHALONIE ROCHELLE (PHARMD, BCACP)
Entity type:Individual
Prefix:DR
First Name:SHALONIE
Middle Name:ROCHELLE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PHARMD, BCACP
Other - Prefix:DR
Other - First Name:SHALONIE
Other - Middle Name:ROCHELLE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:105 CHATIM RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29365-9005
Mailing Address - Country:US
Mailing Address - Phone:864-517-5252
Mailing Address - Fax:
Practice Address - Street 1:41 PARK CREEK DR
Practice Address - Street 2:GOPC: PHARMACY DEPT
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4270
Practice Address - Country:US
Practice Address - Phone:864-299-1600
Practice Address - Fax:864-422-2614
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18433183500000X
SC11661183500000X, 1835P2201X
VA0202207612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183500000XPharmacy Service ProvidersPharmacist