Active NPI
Charles Edward Sullivan, PHARMD
- Pharmacist
- Erie, PA
National Provider Identifier
1104540293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RP456483
- Practice address
- 3800 Pine Ave
Erie, PA 16504-2328 - Phone
- (814) 825-1564
- NPI assigned
- Oct 3, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RP456483 | PA | Primary |
Addresses
Primary practice location
3800 Pine Ave
Erie, PA 16504-2328
Mailing address
1133 W 27TH St
Erie, PA 16508-1523
Phone (814) 572-6642
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP456483 | PA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664755200000",
"number": "1104540293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1133 W 27TH ST",
"city": "ERIE",
"state": "PA",
"postal_code": "165081523",
"telephone_number": "814-572-6642"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3800 PINE AVE",
"city": "ERIE",
"state": "PA",
"postal_code": "165042328",
"telephone_number": "814-825-1564"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "CHARLES",
"middle_name": "EDWARD",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-10-03",
"last_updated": "2022-10-03",
"certification_date": "2022-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "PA",
"license": "RP456483",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Erie, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.