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Individual

MELISSA IRENE SULLIVAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PHARMD.

Contact information

Practice address
612 E MAIN ST, HOHENWALD, TN 38462-2008
(931) 796-3284
(931) 796-5081
Mailing address
612 E MAIN ST, HOHENWALD, TN 38462-2008
(931) 796-3284
(931) 796-5081

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
9424
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
9424
TENNESSEE BOARD OF PHARMACY
TN
Enumeration date
01/25/2018
Last updated
01/25/2018
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