Individual
DR. BRADLEY DUANE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
415 E MAIN ST, KINGWOOD, WV 26537-1701
(304) 329-2212
Mailing address
415 E MAIN ST, KINGWOOD, WV 26537-1701
(304) 329-2212
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP0007283
WV
Other
Enumeration date
03/20/2011
Last updated
03/20/2011
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