Active NPI
Michelle Lynn Sullivan
- Pharmacy Technician
- Spokane, WA
National Provider Identifier
1306097316
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy Technician
- License
- VA00052998
- Practice address
- 601 W Riverside Ave
140
Spokane, WA 99201-0621 - Phone
- (509) 624-2111
- NPI assigned
- Oct 8, 2008
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | VA00052998 | WA | Primary |
Addresses
Primary practice location
601 W Riverside Ave
140
Spokane, WA 99201-0621
Mailing address
601 W Riverside Ave
140
Spokane, WA 99201-0621
Phone (509) 624-2111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6028559 | Medicaid | WA |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| VA00052998 | WA | MD | Pharmacy Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Reidt Pharmacy Corperation | Past | Accepting new patients | |
| Reidt Pharmacy Corperation | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Community/Retail Pharmacy
- Spokane, WA
- NPI 1104838572
-
- Long Term Care Pharmacy
- Spokane, WA
- NPI 1417622762
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1223424000000",
"number": "1306097316",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "601 W RIVERSIDE AVE",
"address_2": "140",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992010621",
"telephone_number": "509-624-2111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 W RIVERSIDE AVE",
"address_2": "140",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992010621",
"telephone_number": "509-624-2111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "MICHELLE",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-08",
"last_updated": "2008-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "WA",
"license": "VA00052998",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6028559",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Spokane, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.