Provider Demographics
NPI:1679596803
Name:SULLIVAN, HARRY LEO (RPH)
Entity type:Individual
Prefix:MR
First Name:HARRY
Middle Name:LEO
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 OVERCAST CT
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2192
Mailing Address - Country:US
Mailing Address - Phone:615-896-3876
Mailing Address - Fax:615-907-3851
Practice Address - Street 1:101 OVERCAST CT
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2192
Practice Address - Country:US
Practice Address - Phone:615-896-3876
Practice Address - Fax:615-907-3851
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6780183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist