Organization
SULLIVAN PHARMACEUTICALS INC
Active
Other names
MONTCLAIR PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM SULLIVAN (PHARMACIST IN CHARGE)
(510) 339-9393
Entity
Organization
Contact information
Practice address
6123 LA SALLE AVE, OAKLAND, CA 94611-2801
(510) 339-9393
(510) 339-9394
Mailing address
6123 LA SALLE AVE, OAKLAND, CA 94611-2801
(510) 339-9393
(510) 339-9394
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY38259
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0539431
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHA382590
—
CA
Enumeration date
02/02/2007
Last updated
11/18/2011
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