Individual
MR. CHARLES ROBERT SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
230 E JOHNSON AVE, COOS BAY, OR 97420-1478
(541) 267-1709
Mailing address
230 E JOHNSON AVE, COOS BAY, OR 97420-1478
(541) 267-1709
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0012450
OR
Other
Enumeration date
12/31/2010
Last updated
12/31/2010
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