Individual
MICHAEL SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM.D
Contact information
Practice address
2011 12TH ST NW, ALBUQUERQUE, NM 87104-2301
(505) 247-2353
Mailing address
2011 12TH ST NW, ALBUQUERQUE, NM 87104-2301
(505) 247-2353
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP00008738
NM
Other
Enumeration date
08/18/2017
Last updated
08/18/2017
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