Individual
DR. STACIE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
1625 SIMPSON HIGHWAY 49, MAGEE, MS 39111-4207
(601) 849-3228
Mailing address
543 SIMPSON HIGHWAY 540, MENDENHALL, MS 39114-9065
(601) 919-7557
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E-010525
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E-010525
LICENSE
MS
Enumeration date
12/13/2020
Last updated
12/13/2020
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