# MAURICE E SULLIVAN

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SULLIVAN DRUG OF RAYMOND
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477539732
- **Authorized official:** MAURICE SULLIVAN R.PH. (OWNER)
- **Authorized official phone:** (217) 839-2909

## Contact information

- **Practice address:** 801 N OBANNON ST, RAYMOND, IL 62560-5283
- **Practice address phone:** (217) 229-3022
- **Practice address fax:** (217) 229-3065
- **Mailing address:** PO BOX 588, RAYMOND, IL 62560-0588

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 054007502 | IL | Yes |

## Other

- **Enumeration date:** 12/19/2005
- **Last updated:** 02/16/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2018616 | PK | — |
| 05 | — | 323389477001 | — | IL |