Provider Demographics
NPI:1053737650
Name:O'SULLIVAN, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:O'SULLIVAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PLYMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-4031
Mailing Address - Country:US
Mailing Address - Phone:781-820-0866
Mailing Address - Fax:
Practice Address - Street 1:4 PLYMOUTH AVE
Practice Address - Street 2:
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-4031
Practice Address - Country:US
Practice Address - Phone:781-820-0866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18979183500000X
NH2399183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist