Lacey Jay Sullivan, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

S019202 Issued in AZ

Practice address

4302 W Buckeye Rd Ste 109
Phoenix, AZ 85043-4904

Phone

(800) 379-0092

NPI assigned

Jul 15, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Lacey Jay Roach Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Centerwell Pharmacy, Inc.

  • Specialty Pharmacy
  • Phoenix, AZ
  • NPI 1386384295
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655164800000",
    "number": "1194070235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4302 W BUCKEYE RD STE 109",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850434904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4302 W BUCKEYE RD STE 109",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850434904",
            "telephone_number": "800-379-0092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "LACEY",
        "middle_name": "JAY",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-15",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IA",
            "license": "21887",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AZ",
            "license": "S019202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LACEY",
            "last_name": "ROACH",
            "middle_name": "JAY",
            "credential": "PHARMD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kevin Sullivan
• Khirey Sullivan, AUD
• Kiah Nicole Sullivan, MD
• Kimberly Sullivan, PSY.D.
• Kristen T Sullivan, PNP
• Marion Louise Sullivan, MD
• Meggan Sullivan, LCSW
• Michael Sullivan
• Michele K. Sullivan, OTR
• Michelle Lee Sullivan, LCSW, LISAC

• Pharmacist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Pharmacist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 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.

Verify at the official NPI Registry.