Sullivan Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SULLIVAN PHARMACY INC

Practice address

267 North Main St
Liberty, NY 12754-1846

Phone

(845) 295-5456

Fax

(845) 295-5458

NPI assigned

Oct 3, 2006

Last updated

Feb 27, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Muhammad Khalique Qureshi, RPHNPI 1871774356

Title

Supervising Pharmacist/Owner

Phone

(845) 295-5456

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NY3 enrollments

Enrollment records 3

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Muhammad Khalique Qureshi

  • Pharmacist
  • Brooklyn, NY
  • NPI 1871774356
  NPD Authorized official
• Sonal D Trivedi, PHARMACIST

  • Pharmacist
  • Liberty, NY
  • NPI 1821329905
  NPD
• Tracee Rae Abrams, PHARMD

  • Pharmacist
  • Liberty, NY
  • NPI 1790969863
  NPD (past)
• Joseph W Giangiacomo, RPH

  • Pharmacist
  • Rock Hill, NY
  • NPI 1881767242
  NPD (past)

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677456000000",
    "number": "1194810770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "267 NORTH MAIN ST",
            "city": "LIBERTY",
            "state": "NY",
            "postal_code": "127541846",
            "telephone_number": "845-295-5456",
            "fax_number": "845-295-5458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "267 NORTH MAIN ST",
            "city": "LIBERTY",
            "state": "NY",
            "postal_code": "127541846",
            "telephone_number": "845-295-5456",
            "fax_number": "845-295-5458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLIVAN PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2023-02-27",
        "certification_date": "2023-02-27",
        "status": "A",
        "authorized_official_last_name": "QURESHI",
        "authorized_official_first_name": "MUHAMMAD",
        "authorized_official_middle_name": "KHALIQUE",
        "authorized_official_title_or_position": "SUPERVISING PHARMACIST/OWNER",
        "authorized_official_telephone_number": "845-295-5456",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY NCPDP",
            "identifier": "3343148",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02632740",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sullivan County Boces
• Sullivan County Physical Therapy,PC
• Sullivan County Public Health Services
• Sullivan County Public Health Services
• Sullivan County Public Health Services
• Sullivan Taxi Inc (Sureway Taxi)
• Sullivan Urologic Associates PLLC
• Amanda Sullivan, L.P.N.
• Supplies Four Health Inc.
• Cori Marie Surerus

• Community/Retail Pharmacy in Liberty, NY
• Providers in Liberty, NY by specialty
• Community/Retail Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.