Provider Demographics
NPI:1972702439
Name:SULLIVAN, CAROLINE FRIEND (RPH)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:FRIEND
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 1:7016 SCHOONER ST
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7944
Mailing Address - Country:US
Mailing Address - Phone:843-216-5696
Mailing Address - Fax:
Practice Address - Street 1:1799 N HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3334
Practice Address - Country:US
Practice Address - Phone:843-856-8669
Practice Address - Fax:843-856-1726
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-15
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8515183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8515OtherSTATE LICENSE NUMBER